-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Savannah, US-GA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:47:04
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Atlanta, US-GA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:47:04
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Miami, US-FL
Salary / Rate: Not Specified
Posted: 2025-04-30 08:47:03
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Hartford, US-CT
Salary / Rate: Not Specified
Posted: 2025-04-30 08:47:02
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Dover, US-DE
Salary / Rate: Not Specified
Posted: 2025-04-30 08:47:01
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Wilmington, US-DE
Salary / Rate: Not Specified
Posted: 2025-04-30 08:47:01
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The role will lead the various workstreams of the identity and access management program as the Cyber PMO program winds down/ends at the end of the year.
The program manager will be the central point of contact for program/project related activities across 6 workstreams, manage and update RAID log items, and will partner with the IAM leadership team to deliver the program on time and on budget.
Responsible for the execution of large projects/programs across the company.
Lead and direct the work of assigned resources.
Provide leadership and guidance to cross-functional teams.
Apply project management principles and frameworks to guide and serve teams that deliver technology solutions.
Partner to support agile and product centric ways of working.
Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety.From one tiny Cincinnati grocery store more than a century ago, we've grown into what today is the nation's largest grocer with nearly 2,800 stores in 35 states operating under 28 different names.
As America's grocer, we take pride in bringing diverse teams with a passion for food and people together with one common purpose: To Feed the Human Spirit.
With a history of innovation, we work tirelessly to create amazing experiences for our customers, communities AND each other, with food at the heart of it all.
Here, people matter.
That's why we strive to provide the ingredients you need to create your own recipe for success at work and in life.
We help feed your future by providing the value and care you need to grow.
If you're caring, purpose-driven and hungry to learn, your potential is unlimited.
Whether you're seeking a part-time position or a new career path, we've got a fresh opportunity for you.
Apply today to become part of our Kroger family!
What you'll receive from us:
The Kroger Family of Companies offers comprehensive benefits to support your Associate Well-Being, including Physical, Emotional, Financial and more.
We'll help you thrive, with access to:
* A wide range of healthcare coverage, including affordable, comprehensive medical, dental, vision and prescription coverage, through company plans or collective bargaining agreement plans.
* Flexible scheduling in full- and part-time roles with paid time off, including holiday and sick pay based on eligibility and length of service.
* Emotional and financial support with free counseling through our Employee Assistance Program and free, confidential financial tools and coaching with Goldman Sachs Ayco.
* Valuable associate discounts on purchases, including food, travel, technology and so much more.
* Up to $21,000 in tuition reimbursement over your career, through our industry-leading Continuing Education program.
* Vast potential for growth, through an abundance of industry-leading training programs and diverse career pathways.
For more information about benefits and eligibility, please visit our Benefits Page...
....Read more...
Type: Permanent Location: Blue Ash, US-OH
Salary / Rate: Not Specified
Posted: 2025-04-30 08:47:00
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Sacramento, US-CA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:59
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Jacksonville, US-FL
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:59
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: San Francisco, US-CA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:58
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Colorado Springs, US-CO
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:57
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Bridgeport, US-CT
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:57
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: San Diego, US-CA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:56
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Denver, US-CO
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:55
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Mobile, US-AL
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:55
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Los Angeles, US-CA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:54
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Phoenix, US-AZ
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:53
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Tucson, US-AZ
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:53
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Fort Smith, US-AR
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:52
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Little Rock, US-AR
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:51
-
Description & Requirements
Maximus is currently hiring for a Bilingual Admin - Spanish Linguist to join our EAOS team.
This is a remote opportunity.
Our EAOS contract requires our interpreters/ translators to be responsible for facilitating cross-cultural communication through the process of converting one language into a different language.
Along with simple translation they also relay ideas and concepts between different languages.
To be successful in this position, it is important to thoroughly understand the subject matter in which a translator/ interpreter is working in order to convey information accurately.
Furthermore, translators/ interpreters must be culturally sensitive.
Essential Duties and Responsibilities:
- Works on assignments that are moderately difficult, requiring judgement in resolving issues.
- Perform repetitive clerical steps such as document verification, manage inbound and outbound routine calls, and greeting guests.
- Perform entry-level clerical duties requiring general knowledge and the application of various work methods and procedures.
- Provide administrative support to project and operations management, which may include identifying, anticipating, and meetings needs of all departments.
- Interpreters handle spoken words while translators work with written words.
- An interpreter/translator is responsible for converting a spoken language into another language.
- Attention to detail is crucial, along with understanding what is being communicated in both languages.
- Interpreters must be able to clearly express ideas and thoughts.
- Simultaneous interpreting involves interpreters listening and speaking (or signing) at the same time that another person is signing or speaking.
- Consecutive interpreters will begin interpreting only after the speaker has finished speaking.
- A consecutive interpreter may take notes while listening.
Minimum Requirements
- High School diploma or equivalent with 2-4 years of experience.
- Associate degree preferred.
- May have additional training or education in area of specialization.
- Minimum of three (3) years of translation experience or has a degree in translation studies.
- Must be fluent in English/Spanish.
- Excellent analytical abilities and writing skills.
- Good editing skills.
- Translators must keep in mind cultural references that may need to be explained, including colloquialisms and slang as well as other expressions that may not be able to translate literally.
- English writing and comprehension and basic computer proficiency preferred.
- Extensive reading in English and Spanish preferred.
- Ability to commit to a one-week training schedule of 8:00am - 4:30pm EST Monday - Friday required.
- Ability to work a schedule between the hours of 8am - 4:30pm EST Monday - Friday required.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared interne...
....Read more...
Type: Permanent Location: Cheyenne, US-WY
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:50
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Birmingham, US-AL
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:50
-
Description & Requirements
Maximus is currently hiring for a Bilingual Admin - Spanish Linguist to join our EAOS team.
This is a remote opportunity.
Our EAOS contract requires our interpreters/ translators to be responsible for facilitating cross-cultural communication through the process of converting one language into a different language.
Along with simple translation they also relay ideas and concepts between different languages.
To be successful in this position, it is important to thoroughly understand the subject matter in which a translator/ interpreter is working in order to convey information accurately.
Furthermore, translators/ interpreters must be culturally sensitive.
Essential Duties and Responsibilities:
- Works on assignments that are moderately difficult, requiring judgement in resolving issues.
- Perform repetitive clerical steps such as document verification, manage inbound and outbound routine calls, and greeting guests.
- Perform entry-level clerical duties requiring general knowledge and the application of various work methods and procedures.
- Provide administrative support to project and operations management, which may include identifying, anticipating, and meetings needs of all departments.
- Interpreters handle spoken words while translators work with written words.
- An interpreter/translator is responsible for converting a spoken language into another language.
- Attention to detail is crucial, along with understanding what is being communicated in both languages.
- Interpreters must be able to clearly express ideas and thoughts.
- Simultaneous interpreting involves interpreters listening and speaking (or signing) at the same time that another person is signing or speaking.
- Consecutive interpreters will begin interpreting only after the speaker has finished speaking.
- A consecutive interpreter may take notes while listening.
Minimum Requirements
- High School diploma or equivalent with 2-4 years of experience.
- Associate degree preferred.
- May have additional training or education in area of specialization.
- Minimum of three (3) years of translation experience or has a degree in translation studies.
- Must be fluent in English/Spanish.
- Excellent analytical abilities and writing skills.
- Good editing skills.
- Translators must keep in mind cultural references that may need to be explained, including colloquialisms and slang as well as other expressions that may not be able to translate literally.
- English writing and comprehension and basic computer proficiency preferred.
- Extensive reading in English and Spanish preferred.
- Ability to commit to a one-week training schedule of 8:00am - 4:30pm EST Monday - Friday required.
- Ability to work a schedule between the hours of 8am - 4:30pm EST Monday - Friday required.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared interne...
....Read more...
Type: Permanent Location: Eau Claire, US-WI
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:49
-
Description & Requirements
Maximus is currently hiring for a Bilingual Admin - Spanish Linguist to join our EAOS team.
This is a remote opportunity.
Our EAOS contract requires our interpreters/ translators to be responsible for facilitating cross-cultural communication through the process of converting one language into a different language.
Along with simple translation they also relay ideas and concepts between different languages.
To be successful in this position, it is important to thoroughly understand the subject matter in which a translator/ interpreter is working in order to convey information accurately.
Furthermore, translators/ interpreters must be culturally sensitive.
Essential Duties and Responsibilities:
- Works on assignments that are moderately difficult, requiring judgement in resolving issues.
- Perform repetitive clerical steps such as document verification, manage inbound and outbound routine calls, and greeting guests.
- Perform entry-level clerical duties requiring general knowledge and the application of various work methods and procedures.
- Provide administrative support to project and operations management, which may include identifying, anticipating, and meetings needs of all departments.
- Interpreters handle spoken words while translators work with written words.
- An interpreter/translator is responsible for converting a spoken language into another language.
- Attention to detail is crucial, along with understanding what is being communicated in both languages.
- Interpreters must be able to clearly express ideas and thoughts.
- Simultaneous interpreting involves interpreters listening and speaking (or signing) at the same time that another person is signing or speaking.
- Consecutive interpreters will begin interpreting only after the speaker has finished speaking.
- A consecutive interpreter may take notes while listening.
Minimum Requirements
- High School diploma or equivalent with 2-4 years of experience.
- Associate degree preferred.
- May have additional training or education in area of specialization.
- Minimum of three (3) years of translation experience or has a degree in translation studies.
- Must be fluent in English/Spanish.
- Excellent analytical abilities and writing skills.
- Good editing skills.
- Translators must keep in mind cultural references that may need to be explained, including colloquialisms and slang as well as other expressions that may not be able to translate literally.
- English writing and comprehension and basic computer proficiency preferred.
- Extensive reading in English and Spanish preferred.
- Ability to commit to a one-week training schedule of 8:00am - 4:30pm EST Monday - Friday required.
- Ability to work a schedule between the hours of 8am - 4:30pm EST Monday - Friday required.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared interne...
....Read more...
Type: Permanent Location: Rock Springs, US-WY
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:48
-
Description & Requirements
Maximus is currently hiring for a Consultant - Medical (RN) Case Reviewer 2 to join our WCRC team.
This is a remote opportunity.
The Consultant will review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Become a subject matter expert (SME) using job aides and learning tools.
- Work on special projects as assigned.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Relevant professional experience can be considered in lieu of Bachelor's degree.
- Valid RN licensure required.
- Ability to commit to a two-week training period between the hours of 9:00am - 6:00pm EST Monday - Friday required.
- Flexibility in work hours, post-training, to include more than 40-hours a week based on business needs required.
- Possess ample medical knowledge and experience with medical terminology...
....Read more...
Type: Permanent Location: Montgomery, US-AL
Salary / Rate: Not Specified
Posted: 2025-04-30 08:46:48
