-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Idaho Falls, US-ID
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:36
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Boise, US-ID
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:35
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Indianapolis, US-IN
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:35
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Tallahassee, US-FL
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:34
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Atlanta, US-GA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:33
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Tampa, US-FL
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:33
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Savannah, US-GA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:32
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Jacksonville, US-FL
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:32
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Miami, US-FL
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:30
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Dover, US-DE
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:29
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: San Diego, US-CA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:28
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: San Francisco, US-CA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:27
-
Lead Service Associate
Contribute to our mission to improve Health and Wellness in your community.
Become a Rite Aid Lead Service Associate, today!
As a Lead Service Associate, you will supervise Store Associates while assisting in daily store operations.
Your purpose is to provide direction where needed and be an ongoing example of superior customer service.
Why you will THRIVE here:
You love to help people.
You are a natural leader who builds solid professional relationships.
You enjoy jumping in and being the hero.
You consistently exceed people's expectations.
You are passionate about providing top-notch customer service.
You have a keen sense of optimizing processes.
Day-in-the-Life of a Lead Service Associate:
* Supervise and help Store Associates with daily operational tasks.
* Assist customers with their shopping needs and transactions.
* Tend to merchandising tasks via plan-o-gram.
* Perform proper receiving and stocking procedures.
* Count and reconcile cash register drawers.
* Prepare deposits and order change from the bank.
* Ensure store inventory is regularly inspected, removed, or rotated according to the Product Freshness Review Schedule.
* Maintain a safe, clean, and pleasing environment for customers and associates.
* Design a monthly schedule and assign work to foster an efficient and effective workflow.
Education and/or Experience:
* H.S.
Diploma or General Education Degree (GED) required.
* At least one (1) year of experience in retail, food service, restaurant, or customer service industry, preferably at a supervisor level.
What's in it for you?
In an effort to improve and sustain the health and wellness of our employees, we offer competitive health plans, generous paid time off, 401K matching, and career growth opportunities! From the moment you join our team, we will provide an environment that inspires and motivates you to choose to work here so you can reach your full potential.
We support personal growth and achievements.
We dedicate ourselves to creating an experience for all our associates that is easy, exciting, and engaging.
Apply to become a Rite Aid Lead Service Associate and thrive with us today!
JR049412
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Type: Permanent Location: Fresno, US-CA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:27
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Bridgeport, US-CT
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:26
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Sacramento, US-CA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:25
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Wilmington, US-DE
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:25
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Colorado Springs, US-CO
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:24
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Denver, US-CO
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:24
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Hartford, US-CT
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:23
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Phoenix, US-AZ
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:22
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Fort Smith, US-AR
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:21
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Little Rock, US-AR
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:20
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Mobile, US-AL
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:20
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
....Read more...
Type: Permanent Location: Los Angeles, US-CA
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:19
-
Description & Requirements
Maximus is currently hiring for a Consultant - Nurse to join our State East Appeals team.
This is a remote opportunity.
The Consultant - Nurse is responsible for composing written determinations as the final output in the process of independent third-party review.
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 cases to identify and summarize key facts of each case and assess issues involved in the appeal.
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract.
- Determine the adequacy of medical records and request relevant medical records as needed.
- Review expert review findings and prepare determination letters.
- Communicate the determination in a succinct written format.
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible.
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed.
- 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.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- LPN required, RN preferred.
- Ability to provide weekend and holiday coverage on scheduled rotation required.
- Flexible work schedule to best support client needs required.
- Experience using PubMed and/or InterQual preferred.
- Experience in health care appeals, health care claims, and familiarity with medical terminology and/or medical record review beneficial.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 o...
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Type: Permanent Location: Tucson, US-AZ
Salary / Rate: Not Specified
Posted: 2025-03-11 07:30:18
