Board Certified in Nursing and licensed to practice in the U.S.
Minimum of five years as an RN in various medical settings.
At least two years of supervisory experience in Medicare coverage rules.
Preferred experience with MR processes related to Medicare Administrative Contractors.
Current RN license is mandatory.
Responsibilities
Supervise the Nurse Review staff to ensure high-quality performance.
Develop and oversee the implementation of medical review processes.
Collaborate with Program Manager and contract staff to enhance project outcomes.
Ensure compliance with established medical review standards.
Guide the nursing team in their daily review activities.
Benefits
Standard Monday to Friday work schedule from 8:30 am to 5:00 pm.
Full Job Description
Saratoga Medical has an immediate opening for a Medical Review Manager for a program supporting the Centers for Medicare and Medicaid Services (CMS) in Catonsville, MD. The work hours are Monday to Friday from 8:30 am to 5:00 pm.
Qualifications:
* Board Certified in Nursing and licensed to practice nursing in the U.S. and a currently licensed RN
* Minimum of five years of experience practicing as an RN in either an acute hospital, skilled nursing facility, or an office/clinic-based medical practice
* Minimum of two years of experience of supervisory experience with Medicare's program coverage and payment rules
* Experience in MR processes of Medicare Administrative Contractors (MACs), CERT, Supplemental Medical Review Contractor (SMRC), or Railroad Retirement Board (RRB) MAC is preferred
Responsibilities:
*Supervise the Nurse Review staff
* Development, oversight, and implementation of the CERT accuracy medical review processes while supervising the medical review nurses
* Collaborate with the Program Manager, CMD, and other contract staff
