FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Medical Review Manager
Accenture Federal Services. Serve as CMS’s primary point of contact for medical review program activities .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive knowledge of Medicare program rules, medical review processes, and clinical review judgment, while effectively managing medical review projects and ensuring compliance with CMS requirements. Holds a Registered Nurse license and possesses significant clinical experience in acute care settings.
Highest-signal resume keywords
Registered Nurse LicenseMedicare Program KnowledgeMedical Review ExperienceManagement ExperienceClinical Review Judgment
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Review ProcessesAnalysis of Medicare ClaimsClinical Review OversightQuality AssuranceDocumentation Methodology
Soft Skills
CollaborationLeadershipCommunication
Certifications & Qualifications
Registered Nurse License
Industry Keywords
Acute Care HospitalSkilled Nursing FacilityOffice/Clinic-Based Medical PracticeCMS RequirementsQuality Oversight
About the role
Key responsibilities & impact- Serve as CMS’s primary point of contact for medical review program activities
- Collaborate with the Contractor Medical Director to manage, evaluate, and ensure quality of all medical review projects
- Lead, coordinate, and oversee medical review activities in compliance with all CMS requirements
- Provide continuous quality oversight and ensure proper documentation, methodology, and reviewer accuracy
- Plan, implement, quality-check, and evaluate CMS-directed medical review projects
- Oversee clinical review auditors
Requirements
What you’ll need- Minimum 5 years of clinical experience in an acute care hospital, skilled nursing facility, or office/clinic-based medical practice
- Minimum 5 years of previous medical review experience
- Minimum 3 years of management experience
- Extensive knowledge of the Medicare program, including coverage and payment rules
- Extensive knowledge of medical review processes
- Extensive knowledge of medical terminology
- Extensive knowledge of analysis and processing of Medicare claims
- Extensive knowledge of clinical review judgment
- Must be a Registered Nurse licensed in a U.S. state, D.C., Puerto Rico, or U.S. territory
- Master’s degree in nursing or a related field OR bachelor’s in nursing with required relevant experience
- Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States
Benefits
Comp & perks- Collaborative and caring community
- Hands-on experience
- Certifications
- Industry training
- Wide variety of benefits
- Reasonable accommodations for disabilities or religious observances