Medical Review Manager

This is a Fully Remote Job
About Our Client:
The organization operates in the government technology and consulting sector, supporting US federal agencies across defense, national security, public safety, civilian, and military health. It addresses the challenge of enhancing government operations and services through technology and expertise, aiming to strengthen national safety and improve citizens' lives.
About the Opportunity:
The MEDICAL REVIEW MANAGER role serves as the main liaison between the Centers for Medicare & Medicaid Services (CMS) and the contractor. The position is responsible for planning, implementing, and evaluating CMS-directed medical review projects while overseeing clinical review auditors. This role ensures the quality and compliance of medical review activities, directly impacting the accuracy and effectiveness of Medicare claims assessment.
Responsibilities:
Act as CMS's primary contact for medical review program activities.
Collaborate with the Contractor Medical Director to manage and evaluate all medical review projects.
Lead and coordinate medical review activities in compliance with CMS requirements.
Provide ongoing quality oversight, ensuring proper documentation, methodology, and reviewer accuracy.
Requirements:
Minimum 5 years of clinical experience in acute care hospitals, skilled nursing facilities, or office/clinic-based medical practice.
At least 5 years of medical review experience.
Minimum 3 years of management experience.
Extensive knowledge of Medicare program rules, medical review processes, medical terminology, Medicare claims analysis, and clinical review judgment.
Registered Nurse licensed in a U.S. state, D.C., Puerto Rico, or U.S. territory.
Master’s degree in nursing or related field, or Bachelor’s in nursing with relevant experience.
Pay Range and Compensation Package:
The base pay range for this position in specified states is $98,100 to $197,400 USD.
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes