Job ID: 24-04101

Registered Nurse Medical Review Medicaid Medicare
Baltimore MD
Pay From: $45 Per Hour

MUST:
The Registered Nurse Medical Review Manager Medicaid Medicare Reviewer s experience includes but is not limited to the following:
Licensed as a Registered Nurse
5+ years of clinical experience as a Registered Nurse
5+years of medical review experience in Medicare PI investigations or demonstrated experience reviewing, analyzing and developing information and making decisions in support of allegations of fraud or abuse.
Experienced with Comprehensive Error Rate Testing Accuracy effort, the Unified Program Integrity Contractor effort or the Supplemental Medical Review Contractor
3+ years of supervisory experience supporting Medicare Part A and B
Experience processing and reviewing Medicare and Medicaid claims including Clinical Review Judgement
Experience handling payment reviews focused on coverage, policy and payment rules, including review of Medicare beneficiary medical records and claims
Proficient with MS Office (Project, Visio, Word, Excel, PowerPoint, Outlook) skills
DUTIES:
The duties of the Medical Review Manager Registered Nurse include but are not limited to the following:
Manage and oversee the delivery of the medical review program with the Centers for Medicare and Medicaid
Support Medicare Part A and B payment reviews focused on coverage
Review Medicare beneficiary medical records and claims using clinical review judgment.
Evaluate and implement the Medical Review and quality control/quality processes
Implement Quality Control/Quality Assurance processes
Ensure timely submission of Program Integrity (PI) required reports
Ensure compliance with Program Integrity Security
Review, analyze, and develop information, and make decisions in support of allegations of fraud, and abuse
Handle the medical review processes of either the Comprehensive Error Rate Testing Accuracy effort, the Unified Program Integrity Contractor effort, or the Supplemental Medical Review Contractor

Quadrant is an affirmative action/equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, status as a protected veteran, or status as an individual with a disability. Healthcare benefits are offered to all eligible employees according to compliance mandated by the Affordable Care Act .