Medical Review Manager

<div class="content-intro"><div> <div> </div> <div>At Accenture Federal Services, nothing matters more than helping the US federal government make the nation stronger and safer and life better for people. Our 13,000+ people are united in a shared purpose to pursue the limitless potential of technology and ingenuity for clients across defense, national security, public safety, civilian, and military health organizations. </div> <div> </div> <div>Join Accenture Federal Services, a technology company within global Accenture. Recognized as a Glassdoor Top 100 Best Place to Work, we offer a collaborative and caring community where you feel like you belong and are empowered to grow, learn and thrive through hands-on experience, certifications, industry training and more. </div> <div> </div> <div>Join us to drive positive, lasting change that moves missions and the government forward!</div> <div> </div> </div></div><p>The Medical Review Manager (MRM) serves as a primary liaison between CMS and the Contractor. Medical Review Manager plans, implements, quality‑checks, and evaluates CMS‑directed medical review projects and oversees clinical review auditors.</p> <p><strong>Primary Responsibilities</strong></p> <ul> <li>Serve as CMS’s primary point of contact for MR program activities.</li> <li>Collaborate with the Contractor Medical Director to manage, evaluate, and ensure quality of all MR projects.</li> <li>Lead, coordinate, and oversee medical review activities in compliance with all CMS requirements.</li> <li>Provide continuous quality oversight and ensure proper documentation, methodology, and reviewer accuracy.</li> </ul> <p><strong>Required Experience</strong></p> <ul> <li>Minimum <strong>5 years of clinical experience</strong> in one or more of the following settings:</li> <ul> <li>Acute care hospital</li> <li>Skilled nursing facility</li> <li>Office/clinic‑based medical practice</li> </ul> <li>Minimum <strong>5 years of previous medical review experience</strong>.</li> <li>Minimum <strong>3 years of management experience</strong>.</li> <li>Extensive knowledge of:</li> <ul> <li>Medicare program, including coverage and payment rules</li> <li>Medical review processes</li> <li>Medical terminology</li> <li>Analysis and processing of Medicare claims</li> <li>Clinical review judgment</li> </ul> </ul> <p><strong>Required Education</strong></p> <ul> <li>Must be a <strong>Registered Nurse</strong> licensed in a U.S. state, D.C., Puerto Rico, or U.S. territory.</li> <li><strong>Master’s degree</strong> in nursing or a related field<br><strong>OR</strong></li> <li>Bachelor’s in nursing with required relevant experience.</li> </ul><div class="content-pay-transparency"><div class="pay-input"><div class="description"><p> </p> <p><span class="TextRun SCXW225111203 BCX8" lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW225111203 BCX8">As required by local law, Accenture Federal Services provides reasonable ranges of compensation for hired roles based on labor costs in the states of <strong>California, Colorado, Connecticut, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Ohio, Vermont, Virginia, Washington, and the District of Columbia</strong></span></span><span class="TextRun SCXW225111203 BCX8" lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW225111203 BCX8">. The base pay range for this position in these locations is shown below. Compensation for roles at Accenture Federal Services varies depending on a wide array of factors, including but not limited to office location, role, skill set, and level of experience. Accenture Federal Services offers a wide variety of benefits. </span></span><a class="Hyperlink SCXW225111203 BCX8" href="https://www.accenture.com/us-en/careers/your-future-rewards-benefits" target="_blank"><span class="TextRun Underlined SCXW225111203 BCX8" lang="EN-US" data-contrast="none"><span class="NormalTextRun SCXW225111203 BCX8" data-ccp-charstyle="Hyperlink">You can find more information on benefits here.</span></span></a><span class="TextRun SCXW225111203 BCX8" lang="EN-US" data-contrast="auto"><span class="NormalTextRun SCXW225111203 BCX8"> We accept applications on an on-going basis and there is no fixed deadline to apply.</span></span></p> <p> </p></div><div class="title">The pay range for the states of California, Colorado, Connecticut, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Ohio, Vermont, Virginia, Washington, and the District of Columbia is:</div><div class="pay-range"><span>$98,100</span><span class="divider">—</span><span>$197,400 USD</span></div></div></div><div class="content-conclusion"><div> <div> <div> </div> <div><em><strong><span data-contrast="none">What We Believe</span> </strong></em></div> <div><em>As a company wholly dedicated to serving the US federal government, we bring together the best talent to help reinvent how federal agencies operate and deliver greater value for their mission and the American people. We have an