-
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: Bowling Green, US-KY
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:06
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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: Davenport, US-IA
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:05
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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: Sioux City, US-IA
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:04
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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: Wichita, US-KS
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:03
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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: New Orleans, US-LA
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:01
-
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: Des Moines, US-IA
Salary / Rate: 23.5
Posted: 2024-09-06 09:20:00
-
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
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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: Bridgeport, US-CT
Salary / Rate: 23.5
Posted: 2024-09-06 09:19:43
