-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Wilmington, US-DE
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:24
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Denver, US-CO
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:23
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Sacramento, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:23
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: San Francisco, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:22
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: San Diego, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:22
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Bridgeport, US-CT
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:21
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Los Angeles, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:20
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Colorado Springs, US-CO
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:20
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Mobile, US-AL
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:19
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Fort Smith, US-AR
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:18
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Tucson, US-AZ
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:18
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Little Rock, US-AR
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:17
-
Essential Duties and Responsibilities:
- Perform all job functions in compliance with HIPAA policies and adhere to local and externally relevant health and safety laws and policies.
- Gather and provide necessary information to providers; may include gathering forms, documents, and vital signs necessary to the evaluation.
- Provide a high level of customer service by greeting and directing all visitors, answering inquiries, confirming contact and appointment information, and otherwise facilitating a positive experience.
- Document all actions taken and other pertinent information as it relates to veteran and provider interaction.
- Clean exam rooms between each appointment and otherwise maintain stock and cleanliness of the clinic throughout the day.
- Must live in or near San Diego, CA.
- Must be willing and able to travel to other clinics as needed.
- Must be willing and able to work some weekend shifts (Saturday and Sunday) as needed.
- Valid Driver License required (not currently suspended/revoked/expired).
Minimum Requirements
- High School Diploma or GED required.
- Experience in Microsoft Office (Word/Excel/Outlook) highly preferred.
- Customer service/hospitality industry experience highly preferred.
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
For positions on this contract, Maximus will pay the prevailing wage rate for the location in which the employee is working, as determined by the Department of Labor.
That wage rate will vary depending on locality.
An applicant's salary history will not be used in determining compensation.
Accommodations
Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment.
If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.
Minimum Salary
$
22.97
Maximum Salary
$
22.97
*
....Read more...
Type: Permanent Location: San Diego, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:16
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Phoenix, US-AZ
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:16
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Birmingham, US-AL
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:15
-
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
....Read more...
Type: Permanent Location: Cheyenne, US-WY
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:14
-
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
....Read more...
Type: Permanent Location: Rock Springs, US-WY
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:14
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render 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 medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps 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 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
- Must have a smartphone which will be required to log into Maximus systems
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
Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Annual salary is just one component of Maximus's total compensation package.
Other rewards may include short- and long-term incentives as well as program-specific awards.
Additionally, Maximus provides a variety of benefits to employees,...
....Read more...
Type: Permanent Location: Montgomery, US-AL
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:13
-
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
....Read more...
Type: Permanent Location: Seattle, US-WA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:12
-
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
....Read more...
Type: Permanent Location: Eau Claire, US-WI
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:12
-
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
....Read more...
Type: Permanent Location: Milwaukee, US-WI
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:11
-
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
....Read more...
Type: Permanent Location: Spokane, US-WA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:10
-
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
....Read more...
Type: Permanent Location: Morgantown, US-WV
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:10
-
Essential Duties and Responsibilities:
- Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments.
- Provide written clinical rationales for CA Workers Compensation cases.
- Review, organize and identify all medical records provided for CA workers comp cases.
- Monitor timeliness of reviews to ensure applicable standards are met.
- Consistently meet production and quality standards.
- Perform special projects as assigned such as legal research, general medical research, etc.
- Work on special projects to improve CA IMR project or other special projects as assigned.
- Become a subject matter expert (SME) using job aides and learning tools.
- Review and evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
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Type: Permanent Location: Roanoke, US-VA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:09
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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 evaluate proposed Medicare set-aside arrangements, including submitted medical records, to determine if the proposed settlement meets the threshold requirements established for beneficiaries and potential beneficiaries and adequately considers Medicare's interests as pertaining to future medical service needs of beneficiaries.
- Ensure all basic documentation requirements are available or requested via development action prior to review by medical and pharmacy review personnel.
- Render medical/clinical determinations based on professional experience.
- Implement operating rules and CMS policy.
- Audit complex determinations for other clinical review programs utilizing medical records to ensure compliance with the organization's coding procedures and standards.
- Provide written clinical rationales for Workers Compensation cases.
- Review, organize and identify all medical records provided for workers comp cases.
- Other duties as assigned by management.
Minimum Requirements
- Bachelor's degree with 3-5 years of experience consulting within designated function.
- Extensive documentation review and/or medical review experience.
- Possess ample medical knowledge and experience with medical terminology, ICD-9/10 Codes, Current Procedure Terminology Codes (CPT) codes, with exposure to applying actual costs and workers' compensation fee schedules in pricing medical items and services.
- Availability during core business hours EST Monday - Friday.
- Ability to commit to a training period with zero absences (to include pre-planned vacations).
- Ability to pass a Federal Suitability Clearance.
Preferred Skills and Qualifications:
- Bachelor's degree from an accredited institution in Nursing, Pharmacy (PharmD), or other healthcare-related clinical discipline.
- Active, valid RN licensure.
- Medicare Set-Aside Certified Consultant (MSCC) certification (obtainable within 3 months of hire).
- Medical/Utilization Review experience.
- Medicare Set-Aside Arrangement experience.
Additional Knowledge of:
- Healthcare Common Procedure Coding System (HCPCS) coding practices.
- Medicare coverage guidelines.
- Anatomy, physiology, and pharmacology.
- Clinical practice guidelines.
- Utilization review standards and pract...
....Read more...
Type: Permanent Location: Tysons, US-VA
Salary / Rate: Not Specified
Posted: 2026-08-16 12:56:08
