Sr Coordinator - Clinical Ops, LPN (remote)

Description & Requirements

Maximus is currently hiring for a Sr Coordinator - LPN to join our QIC DME team.

The Sr Coordinator - LPN is responsible for medical reviews and applying Medicare coverage criteria following project guidelines.

-This is a remote opportunity.



*Position is contingent upon contract award

*

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.

- Provides clinical review on Medicare Appeals reviewing clinical data and application of Medicare Law for QIC Part B

- Reviews cases to determine and summarize the facts of each case and assesses issues involved in the case.

- Render reconsideration determinations on Medicare appeals.

- Will utilize search engines tools to research issues using federal or law, federal regulations, and relevant CMS policies.

- Write the rationale rendering a determination in a clearly written letter is sent to all appropriate parties as required by the specific client contract.

- Ensures all data collected in a case file is accurate and enters and maintains data to related appeal computer tracking system.

- Performs other duties as assigned by management

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

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 or 6 ethernet patch cable to the home router

- Private work area and adequate power source

- Must currently and permanently reside in the Continental US

EEO Statement

Maximus is an equal opportunity employer.

We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.

Annual salary is just one component of Maximus's total compensation package.

Other rewards may...