• Manage and oversee medical review operations, including accuracy reviews, disputes, RAC topic evaluations, and special studies. • Lead and supervise medical review staff to ensure proper application of Medicare policies and procedures. • Provide clinical expertise and guidance for complex or questionable claim review situations. • Conduct quality assurance (QA) audits to verify compliance with contract and regulatory requirements. • Brief, train, and educate review personnel on policy interpretation and validation processes. • Stay current on medical practice, technology changes, billing trends, and potential areas of improper payments. • Ensure medical review activities align with CMS FFS Recovery Audit Program requirements. • Serve as the clinical resource for Medicare coverage, documentation, coding, and regulatory requirements. • Maintain timely communication with CMS and internal leadership as required. • Ensure that all duties requiring clinical expertise are performed directly by the MR Manager; non-medical staff may not substitute.