Job Description

OVERVIEW

We are seeking a skilled and experienced Medical Review Manager to join our team! In this important role, you will have the opportunity to ensure adherence to the Medical Review (MR) function within our organization, focusing on Medicare Fee for Service payment accuracy reviews. You will collaborate closely with the Program Director and provide valuable technical assistance to CMS and our staff as needed. This is a full-time remote position.

In this role, you will support the Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) in their mission to serve the public as a trusted partner. We are dedicated to advancing health equity, expanding coverage, and improving health outcomes for all.

Key Responsibilities:

Oversee and manage the Medical Review process to ensure compliance and accuracy.
Communicate effectively with the Program Director and CMS staff.
Provide technical assistance and guidance on Medicare coverage and payment rules.
Qualifications:

A minimum of three years of experience as a licensed Registered Nurse.
At least three years of supervisory or managerial experience in the health insurance industry, a utilization review firm, or another healthcare claims processing organization, specifically in medical and coding reviews of various medical and surgical claims.
Extensive knowledge of the Medicare program, particularly related to coverage and payment rules.
Education, Licensure, and Certification:

Bachelor's Degree in Nursing.
Current Registered Nurse Licensure.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) Certification is preferred, or demonstrated coding knowledge and experience, with active enrollment in a CPC/CCS certification course to be completed within twelve months.
We value diversity and are proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status, and we do not discriminate based on disability.
Employment Type: Full-Time
Salary: $ 75,568.00 Per Year

Job Tags

Full time, Remote job,

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