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Medical Review Manager
WI - Milwaukee
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Opportunity Snapshot
You will be in on the ground floor of a program integrity opportunity in support of CMS and join a company rich with career growth options. Health Management Services (HMS) is an industry leader in the coordination of program integrity and benefits services for government healthcare programs. Federal Health programs are increasingly the focus of the future of healthcare. With the number of beneficiaries growing rapidly in both Medicare and Medicaid, program oversight on fraud, waste and abuse will continue to be an important aspect of how to safeguard dollars spent in healthcare now and in the future.
HMS is looking for leaders to join the team in crafting solutions to assist CMS in their efforts to fight fraud, waste and abuse. To be a good fit for this opportunity you will have significant experience and a track record of success in your field. We're looking for strong leaders who complement their technical expertise with solid interpersonal skills and a collaborative approach.
Since 1985 HMS has focused exclusively on the healthcare industry and during that time we have partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars, and save billions more through cost avoidance. Our portfolio of services, one of the broadest in the industry, includes coordination of benefits for Medicaid-Medicare, third-party liability, and pharmacy services; overpayment recovery; provider audits; medical support enforcement; and more. While other companies are cutting back, HMS has posted 18% growth year over year since 2001 -- yet we still maintain an entrepreneurial small-company culture in which individuals can make a difference and drive their own careers.
What Else You'll Bring to the Table
In addition to the qualifications detailed above, you'll need:
An active Registered Nurse license.
A bachelor's degree in nursing is preferred but not required.
At least six years of professional experience, including at least three years in a supervisory capacity, in the general area of medical/ utilization review and Medicare is preferred.
What's in It for You
Right time, right place to make an impact -- with billions of dollars at stake, there is a strong emphasis among policy leaders (and the voting public) on cost containment and payment accuracy. Not only will you be able to "make your mark" as this program evolves, but you'll also become part of our Program Integrity division, a product line driven by an aggressive growth strategy.
Career opportunities -- we're hiring now with an eye on the future, looking for impact players who can grow with us. We already have a strong presence in both Medicare and Medicaid, and this program is just one of many examples of our determination to expand into new product areas.
A culture of growth and transition -- while we are growing strongly, we maintain the culture of a smaller company: employee input is welcome, and even new employees can make a visible impact in short order. Because of our growth we are looking for people with the initiative and resourcefulness to "take the ball and run with it." Excellence and innovation are highly valued.
Excellent compensation -- in addition to a competitive salary, we offer a comprehensive benefits package that includes all you would expect plus a few pleasant surprises, such as a 401(k) plan with generous employer match, flexible spending plans, and much more.
More About Your Role
If you're a good fit for this position, you already know most of what this job entails. However, to be sure we're providing a complete picture, here are some details.
Your activities will include:
Managing SOW requirements related to medical review functions for all task orders, including those performed by subcontractors.
Hiring and training qualified professional staff.
Ensuring that the appropriate professional personnel are assigned to medically review cases and that medical review activities are conducted timely and accurately.
Developing and implementing a quality assessment process to assure that decisions made by medical review staff are accurate and consistent.
Focusing reviews on the highest areas of program vulnerability or impact.
Keys to Success
While your technical expertise will be of prime importance, you also will need to remain flexible and see beyond the given as we establish new processes and systems. We'll also look to you to keep an eye out for opportunities to improve these processes. In addition, you'll need strong leadership skills, including the ability to influence and motivate others.
If this sounds like the right mix of challenge and opportunity for you, and you meet the minimum qualifications, we want to hear from you!
Who We Are
Health Management Systems has always been focused exclusively on the healthcare industry. In 1985, we began providing third party liability identification and recovery services to our first Medicaid agency client. Since then, we've partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars and save billions more through cost avoidance.
We take a proactive approach to growing our company, both organically and via mergers and acquisitions, to ensure we provide our clients with a broad offering of best-of-breed cost containment strategies to meet their financial and operational goals.
Opportunity Snapshot
You will be in on the ground floor of a program integrity opportunity in support of CMS and join a company rich with career growth options. Health Management Services (HMS) is an industry leader in the coordination of program integrity and benefits services for government healthcare programs. Federal Health programs are increasingly the focus of the future of healthcare. With the number of beneficiaries growing rapidly in both Medicare and Medicaid, program oversight on fraud, waste and abuse will continue to be an important aspect of how to safeguard dollars spent in healthcare now and in the future.
HMS is looking for leaders to join the team in crafting solutions to assist CMS in their efforts to fight fraud, waste and abuse. To be a good fit for this opportunity you will have significant experience and a track record of success in your field. We're looking for strong leaders who complement their technical expertise with solid interpersonal skills and a collaborative approach.
Since 1985 HMS has focused exclusively on the healthcare industry and during that time we have partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars, and save billions more through cost avoidance. Our portfolio of services, one of the broadest in the industry, includes coordination of benefits for Medicaid-Medicare, third-party liability, and pharmacy services; overpayment recovery; provider audits; medical support enforcement; and more. While other companies are cutting back, HMS has posted 18% growth year over year since 2001 -- yet we still maintain an entrepreneurial small-company culture in which individuals can make a difference and drive their own careers.
What Else You'll Bring to the Table
In addition to the qualifications detailed above, you'll need:
An active Registered Nurse license.
A bachelor's degree in nursing is preferred but not required.
At least six years of professional experience, including at least three years in a supervisory capacity, in the general area of medical/ utilization review and Medicare is preferred.
What's in It for You
Right time, right place to make an impact -- with billions of dollars at stake, there is a strong emphasis among policy leaders (and the voting public) on cost containment and payment accuracy. Not only will you be able to "make your mark" as this program evolves, but you'll also become part of our Program Integrity division, a product line driven by an aggressive growth strategy.
Career opportunities -- we're hiring now with an eye on the future, looking for impact players who can grow with us. We already have a strong presence in both Medicare and Medicaid, and this program is just one of many examples of our determination to expand into new product areas.
A culture of growth and transition -- while we are growing strongly, we maintain the culture of a smaller company: employee input is welcome, and even new employees can make a visible impact in short order. Because of our growth we are looking for people with the initiative and resourcefulness to "take the ball and run with it." Excellence and innovation are highly valued.
Excellent compensation -- in addition to a competitive salary, we offer a comprehensive benefits package that includes all you would expect plus a few pleasant surprises, such as a 401(k) plan with generous employer match, flexible spending plans, and much more.
More About Your Role
If you're a good fit for this position, you already know most of what this job entails. However, to be sure we're providing a complete picture, here are some details.
Your activities will include:
Managing SOW requirements related to medical review functions for all task orders, including those performed by subcontractors.
Hiring and training qualified professional staff.
Ensuring that the appropriate professional personnel are assigned to medically review cases and that medical review activities are conducted timely and accurately.
Developing and implementing a quality assessment process to assure that decisions made by medical review staff are accurate and consistent.
Focusing reviews on the highest areas of program vulnerability or impact.
Keys to Success
While your technical expertise will be of prime importance, you also will need to remain flexible and see beyond the given as we establish new processes and systems. We'll also look to you to keep an eye out for opportunities to improve these processes. In addition, you'll need strong leadership skills, including the ability to influence and motivate others.
If this sounds like the right mix of challenge and opportunity for you, and you meet the minimum qualifications, we want to hear from you!
Who We Are
Health Management Systems has always been focused exclusively on the healthcare industry. In 1985, we began providing third party liability identification and recovery services to our first Medicaid agency client. Since then, we've partnered with more than 45 Medicaid agencies, other state health programs, and more than 50 government-sponsored healthcare plans to help them recover billions of dollars and save billions more through cost avoidance.
We take a proactive approach to growing our company, both organically and via mergers and acquisitions, to ensure we provide our clients with a broad offering of best-of-breed cost containment strategies to meet their financial and operational goals.
HMS is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
