Medicaid Medical Review SME

The Opportunity:

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. You'll work without considerable direction and mentor and may supervise team members.

Join us. The world can't wait.

You Have:

• 3+ years of experience practicing as a licensed Registered Nurse

• 3+ years of experience in a supervisory or managerial role in the health insurance industry, a utilization review firm, or health care claims processing organization, including performing medical and coding reviews of multiple medical and surgical claims from multiple provider types

• Experience performing MR, utilization, or QA reviews

• Knowledge of state and federal healthcare regulations, policies, coverage guidelines, and reimbursement rules in making clinical determinations as to the medical necessity and appropriateness of services rendered and billed and corresponding payment determinations

• Knowledge of the Medicaid or CHIP program, including the coverage, conditions of payments, and state-specific policy requirements for health care coverage and payment

• Public Trust

• Bachelor's degree

• Ability to obtain a Coding Certification such as CPC Certification within 12 months of hire date

• Registered Nurse License

Vetting:

Applicants selected will be subject to a government investigation and may need to meet eligibility requirements of the U.S. government client; Public Trust determination is required.

Compensation

At Booz Allen, we celebrate your contributions, provide you with opportunities and choices, and support your total well-being. Our offerings include health, life, disability, financial, and retirement benefits, as well as paid leave, professional development, tuition assistance, work-life programs, and dependent care. Our recognition awards program acknowledges employees for exceptional performance and superior demonstration of our values. Full-time and part-time employees working at least 20 hours a week on a regular basis are eligible to participate in Booz Allen's benefit programs. Individuals that do not meet the threshold are only eligible for select offerings, not inclusive of health benefits. We encourage you to learn more about our total benefits by visiting the Resource page on our Careers site and reviewing Our Employee Benefits page.

Identity Statement

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during interviews and assessments. We reserve the right to take your picture to verify your identity and prevent fraud.

Candidate AI Usage Policy

AI is a part of our daily work at Booz Allen, and we are committed to the responsible and ethical use of AI tools. However, we want to ensure a fair candidate process based on your own skills and knowledge. As part of this commitment, the use of artificial intelligence (AI) or other tools to assist with responses during interviews (whether in-person or virtual) is prohibited unless permission is explicitly provided.

Work Model
Our people-first culture prioritizes the benefits of collaboration, whether it occurs in person or virtually. To support engagement and effective communication, employees working virtually are generally expected to have their cameras on during meetings.

• Remote: If this position is listed as remote, there may still be occasions when you are required to work in person at a Booz Allen or customer facility.

• Hybrid: If this position is listed as hybrid, you will be expected to work from a Booz Allen facility frequently, in alignment with leadership expectations and the needs of the role. You may also be required to work from or visit a customer facility.

• Onsite: If this position is listed as onsite, work will primarily be performed at a Booz Allen office or customer facility, where employees will collaborate directly with colleagues and customers as required by the role.

Commitment to Non-Discrimination

All qualified applicants will receive consideration for employment without regard to disability, status as a protected veteran or any other status protected by applicable federal, state, local, or international law.