Registered Nurse Medical Review Manager

Job Summary

A company is looking for a Medical Review Manager - Federal Health (CMS).

Key Responsibilities

• Own and administer the quality assurance process for all medical record reviews
• Manage inter-reviewer reliability and ensure consistent clinical determinations across the review team
• Serve as the primary point of contact with CMS for medical review operations

Required Qualifications

• Active Registered Nurse (RN) licensure required
• Minimum 5 years of clinical experience in an acute care hospital, skilled nursing facility, or office/clinic setting
• Extensive knowledge of Medicare program coverage and payment rules
• Demonstrated experience in the analysis and processing of Medicare claims
• Advanced degree in Nursing, Healthcare Administration, or a closely related field required