-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Rock Springs, US-WY
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:55
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Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Eau Claire, US-WI
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:54
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Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
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Type: Permanent Location: Birmingham, US-AL
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:53
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Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Milwaukee, US-WI
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:53
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Charleston, US-WV
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:52
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Richmond, US-VA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:51
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Spokane, US-WA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:51
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Seattle, US-WA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:50
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Roanoke, US-VA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:49
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Tysons, US-VA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:49
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Provide exceptional customer service to help people live healthier lives by treating our customers/employees in a fair and ethical manner, providing a safe, clean, inclusive environment, being a responsible member of the community, providing the right products, services, and care at the right time with fair and accurate pricing.
Provide direct patient intervention by providing health and wellness services and experiences relevant to the patient as allowable by and consistent with state and federal laws.
Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety.Based primarily in Omaha, Nebraska, Baker's merged with The Kroger Company in 2001.
Today, we're proudly serving Baker's customers in 11 stores in Nebraska.
As part of the Kroger family of companies, 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 Baker's 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 ! Minimum
- High School Diploma or GED
- Must be 18 years of age
- Ability to handle highly confidential information
- Completion of national registration, certification or licensure
Desired
- Any previous comparable experience
- Any equivalent experience of a ...
....Read more...
Type: Permanent Location: Fremont, US-NE
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:48
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: St. George, US-UT
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:47
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Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Salt Lake City, US-UT
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:47
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Burlington, US-VT
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:46
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Bennington, US-VT
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:45
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Lubbock, US-TX
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:45
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: San Antonio, US-TX
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:44
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Rapid City, US-SD
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:43
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Nashville, US-TN
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:42
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Memphis, US-TN
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:41
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Houston, US-TX
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:41
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Dallas, US-TX
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:40
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Columbia, US-SC
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:39
-
Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
....Read more...
Type: Permanent Location: Charleston, US-SC
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:39
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Description & Requirements
Maximus is currently hiring for Consultant - Medical to join our team.
This is a remote opportunity and contingent upon award of contract.
The Consultant will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
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*Please note that this position is contingent upon contract award
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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 provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- 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 that is clear, professional and grammatically correct.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for prior authorization requests (PAR) for assigned 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 clinical 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 Requir...
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Type: Permanent Location: Pittsburgh, US-PA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:43:38
