Job Description

About the Role:

As a Medical Review Manager, you'll play a vital role in ensuring the quality and accuracy of healthcare claims. You'll be working for a leading organization dedicated to advancing health equity, expanding coverage, and improving health outcomes.

Key Responsibilities:

Oversee medical reviews: Supervise a team of medical reviewers responsible for assessing the appropriateness and necessity of healthcare claims.
Ensure compliance: Maintain adherence to Medicare program guidelines and regulations.
Analyze data: Use data analysis to identify trends and improve review processes.
Train and develop: Provide training and mentorship to team members.
Qualifications:

Nursing experience: At least 3 years of experience as a licensed Registered Nurse.
Management experience: A minimum of 3 years of supervisory or managerial experience in the healthcare industry, specifically related to medical and coding reviews.
Medicare expertise: In-depth knowledge of Medicare coverage and payment rules.
Education: Bachelor's degree in Nursing.
Certification: Current Registered Nurse licensure and Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification (or equivalent coding knowledge with commitment to obtaining certification within 12 months).
Benefits:

Join a dynamic and mission-driven organization committed to improving healthcare access and outcomes. Enjoy competitive compensation, comprehensive benefits, and opportunities for professional growth.

Equal Opportunity Employer:

We are an equal opportunity employer and value diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
Employment Type: Full-Time
Salary: $ 199,992.00 Per Year

Job Tags

Full time,

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