Hybrid Remote Supervisor Medical Review SMRC (RN) – Travel 25% – California
- Clinical License RN
- State(s) CA
* Position is eligible for Remote / Work from Home opportunity *
Department: SMRC Med Review
Telecommuting Eligible: Yes
Job Grade: E13
Supervisor SMRC Medical Review
The Supervisor Supplemental Medical Review Contractor (SMRC) Medical Review provides guidance, leadership, planning, and reporting to appropriate individuals of the assigned medical review functions. This position supervises staff to ensure the contract is administering the organization’s contracts with the best possible service and quality while maintaining contract expectations and within budget constraints while optimizing staffing levels.
- Researches and provides guidance to develop and scope assigned projects to ensure compliance with the Statement of Work (SOW), authorization forms, and manual guidance.
- Writes professional, accurate, and effective project reports, reviews tools, and mentors others in business writing skills.
- Requests, reviews, and provides recommendations based on data analysis results.
- Collaborates with other team members to ensure the project progresses as expected.
- Ensure the organization meets contractual obligations and performance standards.
- Maintains a strong technical understanding of the system used to manage Medicare business and the interrelationships between teams and system usage.
- Serves as a Subject Matter Expert (SME) for internal/external customers across multiple parts of Medicare.
- Serves as a point of contact to the Centers for Medicare & Medicaid Services (CMS) and other external stakeholders.
- Maintains knowledge and educates others on the SOW including, but not limited to, operational work, reporting, and deliverables.
- Coaches and develops clinical and frontline staff by encouraging growth and ensuring staff are meeting performance expectations. Initiates disciplinary action when performance does not meet expectations.
- Leads by example by promoting teamwork, recognition, and leadership while demonstrating company values.
- Participates in the budget process as appropriate and operates within and maintains knowledge of the MR budget.
- May perform MR work in support of employees when needed.
Non-Essential Duties and Functions
- Other duties as assigned
- Registered Nurse degree with active, unrestricted RN license
- 2 years’ clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic based medical practice AND
- 2 years’ experience in the Medicare program or other payer experience
- Exposure to Medicare claims processing
- Exposure to data analysis techniques and methodologies
- Knowledge of fraud focused MR activities
- Strong written and verbal communication skills
- Demonstrated ability to research complex Medicare regulations
- Communicates accurate, concise information internally and externally
- Ability to motivate and manage a large group of people
- Ability to direct and maintain a productive and conducive working environment
- Ability to coordinate activities among team
- Ability to problem solve and develop problem solving skills within staff and self
- Demonstrated proficiency in computer skills (e.g. Microsoft Office Suite, working in multiple windows, working in the shared systems)
Above requirements and the following:
- Bachelor’s degree in Nursing or willing to obtain within established timeframe upon acceptance of the position
- 5 years’ clinical experience in an acute care hospital, skilled nursing facility, and / or office/clinic-based medical practice
- 5 years’ experience in the Medicare program with exposure to multiple lines of business (A/B/DME)
- 2 years’ experience working with fraud and MR activities
- Extensive knowledge of the Medicare program to include payment rules, medical terminology, and clinical review judgement
- Previous experience in analysis and processing of Medicare claims
- Strong understanding of nursing theory, techniques, practices and procedures, disease process and body systems, clinical diagnostic procedures and treatment, and skills in applying these to individual cases
- Ability to analyze claims data for exposure trends
- Experience completing root cause analysis using data trends to ensure quality operations
- Demonstrated business writing skills
- Ability to build effective interpersonal relationships within the workplace
- Ability to effectively implement and champion change
- Strong analytical skills and attention to detail
- Maintains composure under pressure
Environment and Cognitive/Physical Demands
- Office Environment
- Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve
- Requires prolonged sitting and telephone use
- Requires the use of office equipment such as computer terminals, telephones, copiers and printers
- Infrequent lifting to 15 pounds
- Infrequent stooping
- Travel up to 25%
Segregation of Duties
Every employee is responsible to perform their duties and responsibilities in accordance with Noridian values, policies and procedures, including but not limited to: Segregation of Duties Principles, HIPAA, Security and Privacy, CMS requirements, the Noridian Compliance Program and any other applicable laws, rules and regulations.
Statement of Other Duties
This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.
Total Rewards Package:
Health, Dental and Vision Insurance, Voluntary Insurance Plans, Health Savings and Flexible Spending Accounts, 401k and Company Match, Company-paid Life Insurance, Education Assistance Program, Paid Sick Leave, Paid Holidays, Increasing PTO Accrual Plan, Medical/Parental/Disability Leave, Workers Compensation, Retiree Benefits, Severance Package, Employee Assistance Program, Financial and Health Wellness Benefits, Casual Dress, Open Office Setting, and Online Learning System.
CMS Access Compliance and Regulation Contingency Statement
Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Noridian’s prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.
Equal Employment Opportunity
Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.
Noridian is a Federal Contractor required to comply with the Executive Order 14042 and the guidance released by the Safer Federal Workforce Task Force. This Order requires us to ensure all employees working on covered contracts are vaccinated against COVID-19 unless approved for an accommodation due to a medical condition or a sincerely held religious belief. All candidates must be fully vaccinated upon their start date or have an approved accommodation. To request an accommodation, please contact our Human Resources department at email@example.com.
As of December 7, 2021 the nationwide Federal Mandate has been put on hold. At this time, candidates would not be required to be vaccinated or have an approved accommodation, however if the Executive Order 14042 / Federal Mandate is deemed Legal by court rulings, candidates and employees would need to comply.
Below is the salary range for potential new hires.
Salary Range: $68,928.86 – $113,369.53
Other Compensation: Incentive Plan
Lifestyle Benefit: $50/month
This job will be closed 03/27/2023 at 8:00AM CST. No further applications will be considered.
Associates or better in Nursing.
Licenses & Certifications
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)