Medicaid Medical Review Sme

Booz Allen Hamilton

Base: $77,600.00 to $176,000.00; bonus/equity: not...
Hybrid
Expert clinical guidance
Technical assistance
Clinical compliance assessment
As the Medicaid Medical Review SME, you will be in direct communication with the Medical Review Manager, Medical Reviewers, and client staff to provide expert clinical guidance and technical assistance, ensuring adherence to the Medical Review requirements

Job Summary

  • As the Medicaid Medical Review SME, you will be in direct communication with the Medical Review Manager, Medical Reviewers, and client staff to provide expert clinical guidance and technical assistance, ensuring adherence to the Medical Review requirements.
  • You will utilize extensive knowledge and proven ability to continually assess and evaluate clinical compliance with relevant regulations, both at a state and federal level.
  • You will also be responsible for developing innovative solutions to complex problems.

Matching Summary

As the Medicaid Medical Review SME, you will be in direct communication with the Medical Review Manager, Medical Reviewers, and client staff to provide expert clinical guidance and technical assistance, ensuring adherence to the Medical Review requirements.

Salary

Base: $77,600.00 to $176,000.00; Bonus/Equity: Not specified; Benefits: Health, life, disability, financial, and retirement benefits, paid leave, professional development, tuition assistance, work-life programs, and dependent care.

Skills & Requirements

Must-have

  • expert clinical guidance
  • technical assistance
  • clinical compliance assessment
  • state and federal regulations
  • innovative solutions

Nice-to-have

  • mentoring team members
  • working without considerable direction

Key Requirements

  • 3+ years of experience practicing as a licensed Registered Nurse
  • 3+ years of experience in a supervisory or managerial role in health insurance, utilization review, or claims processing
  • Experience performing MR, utilization, or QA reviews
  • Knowledge of state and federal healthcare regulations
  • Knowledge of the Medicaid or CHIP program
  • Public Trust clearance
  • Bachelor's degree
  • Ability to obtain a Coding Certification within 12 months
  • Registered Nurse License

Work Rights

Public Trust determination is required

Tailored Resume

Cover Letter