Medical Review Manager
Core
Primary liaison between CMS and the Contractor, planning, implementing, and evaluating CMS-directed medical review projects while overseeing clinical review auditors.
Role type
Senior management-level medical review manager
Builds
CMS medical review programs and audit quality
Domain
US Healthcare / Medicare / Clinical Auditing
Required skills
Medicare program knowledge, medical review processes, medical terminology, claims analysis, clinical review judgment, quality oversight, documentation standards, audit management
Preferred skills
None stated
Technologies
None stated
Responsibilities
Serve as CMS's primary point of contact for MR program activities; Collaborate with the Contractor Medical Director to manage and evaluate MR projects; Lead, coordinate, and oversee medical review activities in compliance with CMS requirements; Provide continuous quality oversight and ensure proper documentation, methodology, and reviewer accuracy
Seniority
Senior, management-level