Sr Coordinator - LPN (remote)

Description & Requirements

Maximus is looking for a Sr Coordinator, LPN.

This is fully remote position.

The Sr Coordinator will be responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals following project guidance.

Essential Duties and Responsibilities:

- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.

- Determine need for and obtain any additional information required to complete actions.

- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.

- Complete reports or documentation in accordance with contract requirements.

- Performs other related duties as assigned.

Sr Coordinator - Clinical Ops, LPN

Essential Duties and Responsibilities:

- Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.

- Determine when escalation or consultation is required with Team Lead, manager or physician.

- Review, organize and identify all medical records provided for DMEPOS cases.

- Provide written clinical rationales for DMEPOS cases.

- Monitor timeliness of reviews to ensure applicable standards are met.

- Consistently meet production and quality standards.

- Perform other related duties and/or special projects as assigned.

- Become a subject matter expert (SME) using job aides and learning tools.

- Work on assignments that are moderately difficult, requiring judgement in resolving issues.

- Understand implications of work and make recommendations for solutions.

- Works on a variety of assignments requiring considerable judgement and initiative.

Minimum Requirements:

- Required: Experience performing medical review for all DMEPOS categories within Medicare

- Required: Current Unrestricted Licensed Practical Nurse (LPN) license valid in the state of practice

- Preferred: Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC with knowledge of CMS Internet Only Manuals and Medicare LCD/LCA requirements

Home Office Requirements:

- Reliable high-speed internet service

- Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity

- Minimum 5 Mpbs upload speeds

- Additional Requirements (i.e., headsets, hard wire connection)

- Private workspace away from others, noise and distractions

Minimum Requirements

Minimum Requirements:
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required

- High School Degree or equivalent required

- Minimum 2 years of clinical experience required

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce.

We recognize your unique skills and experiences, and want to provide...