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Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Eau Claire, US-WI
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:24
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Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Cheyenne, US-WY
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:24
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Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Milwaukee, US-WI
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:23
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Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Morgantown, US-WV
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:22
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Description & Requirements
Maximus is currently hiring for a Sr.
Analyst - Finance and Accounting to join our State Arbitration team.
This is a remote opportunity.
The Sr.
Analyst is responsible for reconciling payments, invoice research, and outreach to relevant State Arbitration entities.
The Sr.
Analyst will act as a liaison between Operations and Finance.
Essential Duties and Responsibilities:
- Responsible for preparation of project financial forecast including loading labor data into corporate model; validating ODC forecast and that overall forecast values are consistent with corresponding client Task Orders; and participating in reviews with management to finalize and submit forecast.
- Prepare any quarterly revenue adjustments required to correct revenue for impact of billed indirect rates exceeding expected actual rates.
- In conjunction with Financial Analyst, track costs, billing/invoice adjustments, contract-to-date expenditures for sub-contractors and temporary labor.
- Oversee/review monthly accruals.
- Prepare monthly variance analysis for management review.
- Provide coverage in the absence of Financial Analyst or Coordinator.
- Responsible for ad hoc reporting requests from Finance Director and Project Director.
- Senior liaison between Finance and Human Resources departments regarding forecasting and job categorization.
- Overall preparation of the monthly CPFF invoice to DOH, including review of supporting schedules prepared by other department staff.
- Support management to respond to ad hoc client requests for supporting documentation, cost allocations/analysis, etc.
- Prepare or oversee preparation of reports.
- Prepare pricing and other cost estimates, including those related to contract amendments/task orders.
- Participate in all internal and external audits and maintains reports and data related to and necessary for audits.
- Ensure the security and privacy of financial information.
- Responsible for adhering to established safety standards.
- Must be able to remain in a stationary position for an extended period of time.
- Occasionally lift, carry, or otherwise move items weighing up to 25 pounds.
- Work is constantly performed in an office environment.
- Perform other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 5+ years of experience.
- Advanced degree or professional designation preferred.
- Develop solutions to a variety of complex problems.
- Work requires considerable judgment and initiative.
- Exert some influence on the overall objectives and long-range goals of the organization.
- Robust knowledge and experience utilizing Microsoft Excel, including Pivot tables required
- Experience with Power BI preferred
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 spee...
....Read more...
Type: Permanent Location: Birmingham, US-AL
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:22
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Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Spokane, US-WA
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:21
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Bennington, US-VT
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:20
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Burlington, US-VT
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:20
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Tysons, US-VA
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:19
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Richmond, US-VA
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:18
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Charleston, US-WV
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:18
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Seattle, US-WA
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:17
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Roanoke, US-VA
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:16
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Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Dallas, US-TX
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:16
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Memphis, US-TN
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:15
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Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: San Antonio, US-TX
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:15
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Lubbock, US-TX
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:14
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Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: St. George, US-UT
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:13
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Overall Job Purpose
Provides day-to-day payroll support to the business units and/or HR Business Partner to ensure that the local/offshore payrolls are promptly and accurately.
Ensures consistent application of policies and procedures.
Job Responsibilities
* Provide effective and efficient support to the HR Business Partner to ensure the smooth running of the payroll of the various countries and business units.
* Provide support to the Team Leader and Team Manager in ensuring that deadlines are compiled.
* Ensures day-to-day payroll related matters are carried out systematically and meticulously.
* Provide day-to-day payroll support and advise to employees pertaining to payroll and tax related matters.
* Compile payroll related information for payroll processing.
* Generate relevant payroll reports according to the timeline.
* Liaise with Tax advisor and upon advice, assist in submission of Expatriate tax return either year or on adhoc basis upon resignation or relocation to another country.
* Provide payroll related information for audit purpose to auditors.
* Manage onshore payroll and offshore payroll on a monthly basis in a timely and accurate manner.
As a regional offshore payroll administrator, it requires understanding of the regulatory requirements of the various countries and their pension plans.
* Check all computation before payment.
Work with AP IPP Administrator to reconcile the International Pension Plan report.
* Provide advice on MAA for all offshore payroll.
Liaison with DMS London, DHL GCC and other AP countries.
* Ensure that all staff’s personal payroll records including banking information are centred in the offshore payroll system.
To liaise with HR Business Partner for AP based expatriate for such information.
* Maintain employee data and ensure that data accuracy.
* Generate timely and accurate reports in accordance to the SRT and other ad-hoc reports.
* Issue employment certification letters upon requests
* Monitor employment pass expiry, probation etc and advise Business HR.
Job Responsibilities
* 3-4 years of relevant working experience
* A relevant Diploma/Post Graduate HR professional qualification
* Advanced knowledge and experience in multiple HRIS system including SAP
* Advanced experience in generating & customizing reports
* Competent in computing tools (Words & Excel)
* Have good knowledge of scope of HR service offering to BHR
* To engage with BHR and provide consultative advice in all aspect of EDA management and M.I.
(Management Information) data reporting.
....Read more...
Type: Permanent Location: Petaling, MY-10
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:13
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Salt Lake City, US-UT
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:12
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Houston, US-TX
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:11
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Pittsburgh, US-PA
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:10
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Charleston, US-SC
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:09
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
....Read more...
Type: Permanent Location: Columbia, US-SC
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:09
-
Description & Requirements
Maximus is currently hiring for Clinical Adjudicators - LPN/RN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
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.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance.
- Review, organize and identify all medical records provided for DMEPOS cases.
- Provide written clinical rationales for DMEPOS cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on assignments that are moderately difficult, requiring judgement in resolving issues.
- Understand implications of work and make recommendations for solutions.
- Works on a variety of assignments requiring considerable judgement and initiatives.
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
- Candidates must be available for a training period scheduled from 8:00am to 4:30pm EST Monday - Friday
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements preferred
- Experience performing medical review for all DMEPOS categories within Medicare preferred
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
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...
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Type: Permanent Location: Providence, US-RI
Salary / Rate: Not Specified
Posted: 2024-11-29 07:38:08
