Medical Director for Medicare Claims Review

2 weeks ago


Ajaccio, Corse, United States Livanta Full time
Overview

Livanta, the largest healthcare quality improvement organization in the United States, is seeking a Medical Director to lead our CMS Comprehensive Error Rate Testing (CERT) medical review team.

About Livanta

We have a unique understanding of beneficiaries and have developed programs that improve beneficiary outcomes, increase satisfaction, and drastically reduce readmission. Our technology-driven approach enables us to inspire a better healthcare system that connects beneficiaries, providers, and payers to improve health outcomes, increase efficiency, and manage costs.

Job Summary

This is a full-time, remote position where you will perform Medicare claims review for payment accuracy determinations as a Lead Medical Review Specialist. You will lead a team of nurse reviewers in making payment accuracy determinations, providing leadership direction and guidance to medical review staff. The successful candidate will have a knowledge and understanding of ICD-10-CM, CPT-4, and HCPCS Level II coding principles.

Responsibilities
  • Second-level claim determinations
  • Lead a team of nurse reviewers
  • Provide leadership direction and guidance to medical review staff
Requirements
  • Registered Nurse with bachelor's degree, associate degree, or diploma in nursing
  • At least three years clinical experience
  • Current license in one or more state
  • Experience supervising medical review teams to ensure quality and production standards
  • Experience applying coverage determinations and relevant policy to Medicare claims as a medical review nurse
  • No adverse actions pending or taken by any license board
Benefits

This position offers a competitive salary range of $85,000 - $115,000 per year, depending on experience. Additionally, we offer telecommuting options and a collaborative work environment.

Career Development

We are committed to supporting your career growth and development. If you are a motivated and experienced professional looking for a new challenge, please apply today.



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