-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Minot, US-ND
Salary / Rate: 82500
Posted: 2024-09-04 08:29:26
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Assistant Store Manager
Contribute to our mission to improve Health and Wellness in your community.
Become a Rite Aid Assistant Store Manager, today!
As an Assistant Store Manager, you are responsible for day-to-day operations, care, and service provided to our customer & patients.
Your purpose is to lead your store to success through mentoring, coaching, and optimizing processes.
Why you will THRIVE here:
You love to help people.
You are a natural leader who builds solid professional relationships.
You enjoy motivating those around you, and you're good at it.
You consistently exceed people's expectations.
You are passionate about providing top-notch customer service.
You have a keen sense for optimizing processes.
Day-in-the-Life of an Assistant Store Manager:
* Understand and manage the operation of your store to maximize profitability.
* Coach associates by motivating the mindset of driving sales through customer service.
* Maintain and analyze P&L reports and inventory logs.
* Uphold cash and bank depository procedures.
* Foster a customer-centric culture and exceed customer experience goals.
* Manage tasks and supervise team members in the absence of the Store Manager.
Education and/or Experience
H.S.
Diploma or General Education Degree (GED) required.
What's in it for you?
In an effort to improve and sustain the health and wellness of our employees, we offer competitive health plans, generous paid time off, 401K matching, and career growth opportunities! From the moment you join our team, we provide an environment that inspires and motivates you to work here and reach your full potential.
We support personal growth and celebrate achievements.
We dedicate ourselves to creating an experience for all our associates that is easy, exciting, and engaging.
Apply to become a Rite Aid Assistant Store Manager and thrive with us today!
JR040747
....Read more...
Type: Permanent Location: Brooklawn, US-NJ
Salary / Rate: Not Specified
Posted: 2024-09-04 08:29:25
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Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Oklahoma City, US-OK
Salary / Rate: 82500
Posted: 2024-09-04 08:29:24
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Columbus, US-OH
Salary / Rate: 82500
Posted: 2024-09-04 08:29:24
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Fargo, US-ND
Salary / Rate: 82500
Posted: 2024-09-04 08:29:23
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Cincinnati, US-OH
Salary / Rate: 82500
Posted: 2024-09-04 08:29:23
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Cleveland, US-OH
Salary / Rate: 82500
Posted: 2024-09-04 08:29:22
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Charlotte, US-NC
Salary / Rate: 82500
Posted: 2024-09-04 08:29:21
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Albuquerque, US-NM
Salary / Rate: 82500
Posted: 2024-09-04 08:29:20
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Wilmington, US-NC
Salary / Rate: 82500
Posted: 2024-09-04 08:29:20
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Cherry Hill, US-NJ
Salary / Rate: 82500
Posted: 2024-09-04 08:29:19
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Rochester, US-NY
Salary / Rate: 82500
Posted: 2024-09-04 08:29:17
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Buffalo, US-NY
Salary / Rate: 82500
Posted: 2024-09-04 08:29:15
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Albany, US-NY
Salary / Rate: 82500
Posted: 2024-09-04 08:29:15
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Las Cruces, US-NM
Salary / Rate: 82500
Posted: 2024-09-04 08:29:14
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Manchester, US-NH
Salary / Rate: 82500
Posted: 2024-09-04 08:29:14
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Newark, US-NJ
Salary / Rate: 82500
Posted: 2024-09-04 08:29:13
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Reno, US-NV
Salary / Rate: 82500
Posted: 2024-09-04 08:29:12
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Las Vegas, US-NV
Salary / Rate: 82500
Posted: 2024-09-04 08:29:12
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: North Platte, US-NE
Salary / Rate: 82500
Posted: 2024-09-04 08:29:11
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Lebanon, US-NH
Salary / Rate: 82500
Posted: 2024-09-04 08:29:11
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Missoula, US-MT
Salary / Rate: 82500
Posted: 2024-09-04 08:29:10
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Tupelo, US-MS
Salary / Rate: 82500
Posted: 2024-09-04 08:29:09
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Omaha, US-NE
Salary / Rate: 82500
Posted: 2024-09-04 08:29:09
-
Description & Requirements
Maximus is looking for a Consultant Appeals.
This is a full-time, fully remote position.
Essential Duties and Responsibilities:
- Subject matter expert for the most complex Appeals and Hearings cases.
- Evaluate data associated with complex customer issues to determine compliance or to make exceptions to applicable regulations and policies; may require contacting the customer to obtain additional information or clarify actions pertinent to the case.
- Research laws and regulations and apply rules to case-specific situations.
- Provide complaint resolution to customers verbally or in writing, utilizing discretion.
- May attend hearings and/or management meetings to discuss cases.
-Review cases to identify and summarize key facts of each case and assess medical and legal issues involved in the case
-Research issues using California law, California regulations, current peer-reviewed medical literature, clinical guidelines, and other sources as defined by the client contract
-Determine the adequacy of medical records and request relevant medical records as needed
-Communicate the determination in a succinct written format
-Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
-Familiarity with medical terminology and/or medical record review required.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
-Familiarity with California health care law/Knox Keene Act and managed health care preferred.
Home Office Requirements:
-Hardwired internet (ethernet) connection.
-Internet download speed of 25mbps single upload or higher required (you can test this by going to www.speedtst.net).
-Private work area and adequate power source.
-Video calls may be requested on occasion.
Proper background and attire is required.
Minimum Requirements:
- Juris Doctorate Required.
- Familiarity with medical terminology and/or medical record review required.
Minimum Requirements
- Bachelor's degree in relevant field of study and 3+ years of relevant professional experience required, or equivalent combination of education and experience.
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 you with a career path that allows you to continue making a difference for our country.
We're proud of our connections to organizations dedicated to serving veterans and their families.
If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you.
A committed and diverse workforce is our most important resourc...
....Read more...
Type: Permanent Location: Kansas City, US-MO
Salary / Rate: 82500
Posted: 2024-09-04 08:29:08
