South Carolina Licensed Medical Review Director

Job Summary

A company is looking for a Senior Medical Review Director to lead and develop staff in the administration of Medical Review and Prior Authorization programs.

Key Responsibilities

• Ensure compliance with CMS directives and analyze the effectiveness of Medical Review and Prior Authorization operations
• Direct the development of the Medical Review and Prior Authorization Program strategy and implement error rate reduction plans
• Manage the budget and maintain proactive relationships with CMS and other Medicare program leadership

Required Qualifications

• Bachelor's degree in a job-related field
• 10 years of experience in healthcare program management, utilization/case management, or medical review management
• Active RN licensure in the state hired, if applicable
• Knowledge of budget preparation and management
• Proficiency in Microsoft Office and medical systems software