-
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: Chicago, US-IL
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:59
-
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: Columbus, US-GA
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:58
-
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: Springfield, US-IL
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:57
-
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: Fort Wayne, US-IN
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:56
-
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: Evansville, US-IN
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:56
-
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: Idaho Falls, US-ID
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:55
-
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: Indianapolis, US-IN
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:54
-
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: Boise, US-ID
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:53
-
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: Savannah, US-GA
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:52
-
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: Miami, US-FL
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:51
-
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: Atlanta, US-GA
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:50
-
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: Tallahassee, US-FL
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:49
-
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: Tampa, US-FL
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:48
-
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-DE
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:48
-
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: Jacksonville, US-FL
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:47
-
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: Dover, US-DE
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:46
-
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: Hartford, US-CT
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:45
-
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: Denver, US-CO
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:44
-
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: Bridgeport, US-CT
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:43
-
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: Colorado Springs, US-CO
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:42
-
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: Los Angeles, US-CA
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:41
-
Pharmacy Technician\Technician in Training
Contribute to our mission to improve Health and Wellness in your community.
Become a Rite Aid Pharmacy Technician today!
As a Pharmacy Technician in Training, you receive free training with our exclusive Rite Aid Pharmacy Technician Training & Certification Program.
Your purpose is to successfully complete the program and continue working as a Rite Aid Pharmacy Technician.
Click here to check out our Pharmacy Technician Video!
Why you will THRIVE here:
You love to help people.
You care about the Health and Wellness of your community.
You have an innate need to find answers where they aren't obvious.
You have a way of making people feel comfortable.
You enjoy an organized environment.
You always remember details.
Your email and phone etiquette are top-notch.
Day-in-the-Life of a Pharmacy Technician in-Training:
* Enter prescription information including but not limited to: patient searches, prescriber searches, drug selection, prescription interpretation, insurance billing, and basic documentation.
* Accept customer and prescription information required to process new and refill prescriptions, including refill authorization from doctor offices.
* Retrieve medication from inventory.
* Create prescription labels and put them on prescription containers.
* Place medication into prescription containers.
* Complete paperwork related to filling prescriptions and input customer and prescription data into the computer.
* Assist with maintaining the Pharmacy department by keeping it clean and in order.
* Assist in inventory management processes including order review, inventory returns, restocking shelves, and physical inventory preparation.
* Administer Rite Aid programs including FlavoRx, Living More, etc.
Taking care of patients is not a 9-5 job.
Our Pharmacy Technicians come into this role knowing that they will be working weekdays, weekends, evening shifts, and some holidays.
Because we work as a team, we all work together to be reasonably flexible to make all of our schedules work.
It is because of the friendly, team-oriented, and welcoming attitude of our Pharmacy Technicians that make Rite Aid the pharmacy of choice for our customers and patients and for our employees.
Qualifications:
H.S.
Diploma or General Education Degree (GED) required.
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 provide an environment that inspires and motivates you to work here and reach your full potential.
We support personal growth and celebrate achievements.
We dedicate ourselves to creating an experience for all our associates that is easy, exciting, and engaging.
Apply to become a Rite Aid Pharmacy Technician/Technician Trainee and thrive with us today!
JR040878
The typ...
....Read more...
Type: Permanent Location: Everett, US-WA
Salary / Rate: Not Specified
Posted: 2024-09-06 09:19:41
-
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: Fort Smith, US-AR
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:40
-
Pharmacy Technician\Technician in Training
Contribute to our mission to improve Health and Wellness in your community.
Become a Rite Aid Pharmacy Technician today!
As a Pharmacy Technician in Training, you receive free training with our exclusive Rite Aid Pharmacy Technician Training & Certification Program.
Your purpose is to successfully complete the program and continue working as a Rite Aid Pharmacy Technician.
Click here to check out our Pharmacy Technician Video!
Why you will THRIVE here:
You love to help people.
You care about the Health and Wellness of your community.
You have an innate need to find answers where they aren't obvious.
You have a way of making people feel comfortable.
You enjoy an organized environment.
You always remember details.
Your email and phone etiquette are top-notch.
Day-in-the-Life of a Pharmacy Technician in-Training:
* Enter prescription information including but not limited to: patient searches, prescriber searches, drug selection, prescription interpretation, insurance billing, and basic documentation.
* Accept customer and prescription information required to process new and refill prescriptions, including refill authorization from doctor offices.
* Retrieve medication from inventory.
* Create prescription labels and put them on prescription containers.
* Place medication into prescription containers.
* Complete paperwork related to filling prescriptions and input customer and prescription data into the computer.
* Assist with maintaining the Pharmacy department by keeping it clean and in order.
* Assist in inventory management processes including order review, inventory returns, restocking shelves, and physical inventory preparation.
* Administer Rite Aid programs including FlavoRx, Living More, etc.
Taking care of patients is not a 9-5 job.
Our Pharmacy Technicians come into this role knowing that they will be working weekdays, weekends, evening shifts, and some holidays.
Because we work as a team, we all work together to be reasonably flexible to make all of our schedules work.
It is because of the friendly, team-oriented, and welcoming attitude of our Pharmacy Technicians that make Rite Aid the pharmacy of choice for our customers and patients and for our employees.
Qualifications:
H.S.
Diploma or General Education Degree (GED) required.
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 provide an environment that inspires and motivates you to work here and reach your full potential.
We support personal growth and celebrate achievements.
We dedicate ourselves to creating an experience for all our associates that is easy, exciting, and engaging.
Apply to become a Rite Aid Pharmacy Technician/Technician Trainee and thrive with us today!
JR040869
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Type: Permanent Location: Huntingdon Valley, US-PA
Salary / Rate: Not Specified
Posted: 2024-09-06 09:19:39
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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...
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Type: Permanent Location: San Francisco, US-CA
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:38
