Consultant - Nurse (remote)

Description & Requirements

Maximus is currently hiring for a Consultant - Nurse to join our QIC DME team.

This is a remote opportunity.



*Position is contingent upon contract award

*

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.

- Render medical necessity determinations for Medicare Part B QIC reconsideration cases assigned.

- Resolve all other technical issues within Medicare Part B QIC reconsiderations assigned

- Review cases to determine and summarize facts of each case assigned and assesses issues involved in the case

- Review file to determine whether all relevant information has been submitted

- Research issues using federal and state law, federal and state regulations, relevant contract law and other sources as defined by the client contract

- 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

- Meet or exceed all performance standards established for this position

- Perform other duties as assigned by management

Minimum Requirements

- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.

- Bachelor's degree or in lieu of degree equivalent experience

- Registered Nurse (RN) license required

- Three Years of Medicare experience preferred

- Medicare work experience in both Part A and Part B

- Must be US Citizen or have lived the last 5 years working continuously for 3

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, expe...