-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
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Type: Permanent Location: Louisville, US-KY
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:09
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
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Type: Permanent Location: Kansas City, US-KS
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:08
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
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Type: Permanent Location: Davenport, US-IA
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:06
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Indianapolis, US-IN
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:06
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Des Moines, US-IA
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:05
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Fort Wayne, US-IN
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:03
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Evansville, US-IN
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:02
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Idaho Falls, US-ID
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:01
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Chicago, US-IL
Salary / Rate: Not Specified
Posted: 2025-11-21 09:35:00
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Springfield, US-IL
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:59
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Columbus, US-GA
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:58
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Boise, US-ID
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:56
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
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Type: Permanent Location: Jacksonville, US-FL
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:55
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Miami, US-FL
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:53
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Atlanta, US-GA
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:52
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Tampa, US-FL
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:51
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Tallahassee, US-FL
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:50
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Savannah, US-GA
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:49
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Dover, US-DE
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:47
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Hartford, US-CT
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:46
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Wilmington, US-DE
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:45
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Sacramento, US-CA
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:44
-
Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
*
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
Max...
....Read more...
Type: Permanent Location: Bridgeport, US-CT
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:44
-
Engineer - Plastics Testing -Plymouth, Michigan
Intertek, a leading provider of quality and safety solutions to many of the world's top-recognized brands and companies, is actively seeking a Test Engineerto join our Transportation Technologies team in Plymouth, Michigan.
This is a fantastic opportunity to grow a versatile career in materials testing.
Intertek's Transportation Technologies team offers Total Quality Assurance expertise, delivered consistently with precision, pace and passion, enables our customers to power ahead safely.
Our automotive, battery and energy storage, and related transportation industry testing and certification expertise is recognized by leading manufacturers worldwide for evaluating how their products and services meet and exceed quality, safety, sustainability and performance standards.
Intertek is continually innovating and evolving to reduce risk for consumers, brands and organizations in every sector and industry around the world.
We go beyond Testing, Inspection and Certification of products: we are a Total Quality Assurance Provider to industries worldwide.
Our Purpose: Bringing quality, safety, and sustainability to life.
What are we looking for?
The Engineer, under general supervision, supports the operations team responsible for providing diverse range of plastics testing and characterization services to global polymer manufacturers, compounders, fabricators and end-users.
Shift/Schedule: Monday - Friday 8am - 5pm
In addition to competitive compensation packages, when working with Intertek you can expect benefits including medical, dental, vision, life, disability, 401(k) with company match, generous vacation / sick time (PTO), tuition reimbursement and more.
What you'll do:
* Set up test apparatus, operate equipment, maintain equipment and facilities
* Prepare test samples and obtain & record test data in accordance with standards
* Perform basic analysis of test data and routine calculations
* Record data and write reports in standardized formats
* Participate in proofing of project reports
* Prepare project files for compliance with operating procedures
* Make recommendations regarding technical decisions relating to the interpretation and applicability of test standards
* Communicate with clients and management regarding tests or improvements
* Assist and instruct laboratory technicians
* Perform other work as required/ assigned
This position outline is a general guideline and does not represent all encompassing details.
The position assumes that the incumbent has both the mental and physical requirements to carry out the above defined duties.
Minimum Requirements & Qualifications:
* Bachelor or Associate Degree in Engineering
* Experience: 0 - 3 years in plastics testing
* Ability to interact externally with clients/prospects, and internally with other departments to ensure customer satisfaction and timely response
* Comput...
....Read more...
Type: Permanent Location: Plymouth, US-MI
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:42
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Description & Requirements
Maximus is currently hiring for an Appeals Nurse to join our State East team.
This is a remote opportunity.
The Appeals Nurse is responsible for facilitating the review portion of the case.
They will review the medical records, prepare the case files for the expert reviewer, and select the expert specialty to conduct the review.
Additionally, they are responsible for completing a quality check of the final document and ensuring the report address the issue at hand and meets all state, and client requirements.
*An active, unrestricted RN License is required for this position
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Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render medical necessity determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written or verbal format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency.
- Ability to respond to the needs of outside contacts.
- Working knowledge and use of PC, MS Word and Excel software.
- Ability to work as a part of a team as well as independently, and promote positive company relations.
- Excellent organizational, interpersonal, written, and verbal communication skills.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Minimum Requirements
- Bachelor's degree required
- Active RN license required.
- Minimum 2 years clinical experience required with RN license.
- Ability to work a schedule of 8:00am - 5:00pm EST Monday - Friday preferred.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Maximus is an equal opportunity employer.
We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
Pay Transparency
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Type: Permanent Location: Colorado Springs, US-CO
Salary / Rate: Not Specified
Posted: 2025-11-21 09:34:41
