-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Portland, US-OR
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:49
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Cincinnati, US-OH
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:48
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Tulsa, US-OK
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:48
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Wilmington, US-NC
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:46
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Buffalo, US-NY
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:45
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Albany, US-NY
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:44
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Minot, US-ND
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:43
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Charlotte, US-NC
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:42
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Rochester, US-NY
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:41
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Fargo, US-ND
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:40
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Albuquerque, US-NM
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:39
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Newark, US-NJ
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:38
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Las Vegas, US-NV
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:37
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Las Cruces, US-NM
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:36
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Lebanon, US-NH
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:35
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Manchester, US-NH
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:34
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Cherry Hill, US-NJ
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:33
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Reno, US-NV
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:32
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Missoula, US-MT
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:31
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Bozeman, US-MT
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:30
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Omaha, US-NE
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:29
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Kansas City, US-MO
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:28
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: North Platte, US-NE
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:27
-
Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: St. Louis, US-MO
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:26
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Description & Requirements
Maximus is currently hiring for a Clinical Adjudicator - LPN to join our QIC DME team.
This is a remote opportunity.
The Clinical Adjudicator - LPN is responsible for medical reviews and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidelines.
Essential Duties and Responsibilities:
- Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations.
- Determine need for and obtain any additional information required to complete actions.
- Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline.
- Complete reports or documentation in accordance with contract requirements.
- Performs other related duties as assigned.
-Responsible for reviewing documentation and applying Medicare coverage criteria to adjudicate clinical DMEPOS appeals, following project guidance
- Review, organize and identify all medical records provided for DMEPOS cases
- Provide written clinical rationales for DMEPOS cases
- Monitor timeliness of reviews to ensure applicable standards are met
- Consistently meet production and quality standards
- Become a subject matter expert (SME) using job aides and learning tools
- Work on assignments that are moderately difficult, requiring judgement in resolving issues
- Understand implications of work and make recommendations for solutions
- Works on a variety of assignments requiring considerable judgement and initiatives
Requirements:
- Minimum of 1 year clinical experience considered in lieu of 2 year requirement
- Experience performing medical review for all DMEPOS categories within Medicare
- Candidates must be available for a training period scheduled from Monday - Friday 8:00am to 4:30pm EST
Minimum Requirements
- Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
Preferred:
- 1 year in Medical Review experience at MAC, ZPIC/UPIC, RAC, SMRC, or QIC
- Experience with MAC, ZPIC / UPIC, RAC, SMRC or QIC
- Knowledge of CMS Internal Only Manuals and Medicare LCD/LCA requirements
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 or 6 ethernet patch cable to the home router
- Private work area and adequate power source
- Must currently and permanently reside in the Continental US
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that great...
....Read more...
Type: Permanent Location: Billings, US-MT
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:25
