Serco is seeking a motivated Medical Review Manager to join our talented and fast-paced Public Sector Solutions team in supporting CMS. The Medical Review Manager position would be responsible for the management, guidance, and oversight of the medical review process to ensure adherence to the relevant contract.

The candidate in this position ideally brings a combination of strong supervisory experience and subject matter expertise in the review of Medicare claims. This position is responsible for the businsess and operational processes to ensure the full optimal medical review function to ensure timely and quality deliver of the program.

As a Medical Review Manager, you will:

• Be in direct communication with the Program Director.
• Provide technical assistance to CMS, staff, subcontractors, and other stakeholders.
• Provide oversight and direction with the medical review protocol necessary for timely completion of the program.
• Ensure the full and complete review of all medical records received to ensure quality medical review of claims.
• Identify opportunities for improvements to streamline and automate review processing to enhance program efficiency and coordination.

In compliance with state and local laws regarding pay transparency, the target salary is $120,000 - $150,000; however, Serco considers several factors when extending an offer, including but not limited to, the role and associated responsibilities, a candidate's work experience, education/training, and key skills.

Meet Your Recruiter!

To be successful in this role, you must have:

• Education, Licensure, and Certification:
• Bachelor’s Degree in Nursing
• Current Registered Nurse Licensure
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) Certification or coding knowledge and experience with active enrollment in CPC/CCS certification course
• 3 years of supervisory/managerial experience in the health insurance industry, a utilization review firm, or another health care claims processing organization involving medical and coding reviews of a variety of medical and surgical claims from a variety of provider types.
• 3 years of experience practicing nursing as a licensed Registered Nurse.
• Extensive knowledge of the Medicare program, particularly the coverage and payment rules.
• Thorough understanding of project/program management techniques and methods.
• Demonstrated knowledge of medical record documentation, medical review protocols, and medical coding.
• Experience with process improvements of medical review and medical coding review protocols.
• An analytical mindset with problem-solving abilities.
• Strong leadership and organizational skills.
• Excellent communication skills, both verbal and written.
• Exceptional interpersonal skills with ability to establish and maintain effective working relationships.
• Enjoy working in a fast-paced and collaborative team environment.

This position can be Hybrid or full-time remote work.

If you are interested in supporting our mission and working with a passionate team - then submit your application now for immediate consideration.  It only takes a few minutes and could change your career!

**Serco Inc. is using this posting for the purpose of responding to a proposal. We are seeking qualified candidates in the event of a contract award. This position is not currently funded/active.  Should Serco be awarded the contract, and you meet the qualifications of the position, you will be considered in the selection process.**

Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco’s 9,000+ employees strive to make an impact every day across 100+ sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.

To review Serco benefits please visit: https://www.serco.com/na/careers/benefits-of-choosing-serco. If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.

Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.

Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com.

Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.