Nurse Manager - Appeals

Description & Requirements

Maximus is currently hiring for a Nurse Manager - Appeals to join our State East - Appeals team.

The Manager is responsible for overseeing a team of clinical staff who are responsible for appeals and case review.



*An active, unrestricted RN License is required for this position

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Essential Duties and Responsibilities:

- Serve as the lead content knowledge expert concerning the review and research of provided clinical information.

- Perform clinical case reviews and consultations

- Provide direct supervision to assigned team of nursing and/or other clinical staff

- Provide subject matter expertise related to medical necessity and level of care criteria and application thereof

- Provides education and clinical training to staff in area of expertise

- Performs other related duties as assigned.

- Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures.

Minimum Requirements

- Current Registered Nurse (RN) license valid in the state of practice is required
- Bachelor's degree and 5 years of experience or equivalent combination of education and experience required
- Minimum of 5 years of clinical experience

- Minimum 1 year supervisory experience preferred

- Healthcare appeals experience preferred.

- Ability to work a schedule of 9:00am - 5:00pm EST Monday - Friday preferred.

-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 and secure 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 include short- and long-term incentives as well as program-specific awards.

Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off.

Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience.

An applicant's salary history will no...