-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Houston, US-TX
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:22
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Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Salt Lake City, US-UT
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:21
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: San Antonio, US-TX
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:21
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Memphis, US-TN
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:20
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Charleston, US-SC
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:19
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Dallas, US-TX
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:19
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Rapid City, US-SD
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:18
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Newport, US-RI
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:18
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Sioux Falls, US-SD
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:17
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Philadelphia, US-PA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:16
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Columbia, US-SC
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:16
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Providence, US-RI
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:15
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Pittsburgh, US-PA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:15
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Tulsa, US-OK
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:14
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Cincinnati, US-OH
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:13
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Eugene, US-OR
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:11
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Columbus, US-OH
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:11
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Oklahoma City, US-OK
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:10
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Cleveland, US-OH
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:10
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Portland, US-OR
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:09
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Charlotte, US-NC
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:08
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Las Cruces, US-NM
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:07
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Rochester, US-NY
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:06
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Albany, US-NY
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:06
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
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Type: Permanent Location: Fargo, US-ND
Salary / Rate: Not Specified
Posted: 2025-03-11 07:31:05
