-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Las Vegas, US-NV
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:43
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Omaha, US-NE
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:42
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Bozeman, US-MT
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:41
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: North Platte, US-NE
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:41
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Billings, US-MT
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:40
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Springfield, US-MO
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:39
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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!
JR050145
....Read more...
Type: Permanent Location: Hanover, US-PA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:39
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: St. Louis, US-MO
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:38
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Kansas City, US-MO
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:37
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Tupelo, US-MS
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:36
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Hattiesburg, US-MS
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:35
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Minneapolis, US-MN
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:34
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Duluth, US-MN
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:34
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Detroit, US-MI
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:33
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Jackson, US-MS
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:32
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Marquette, US-MI
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:32
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Grand Rapids, US-MI
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:31
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Boston, US-MA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:30
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Springfield, US-MA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:30
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Aberdeen, US-MD
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:29
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Baltimore, US-MD
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:28
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Portland, US-ME
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:28
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: Bangor, US-ME
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:27
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
....Read more...
Type: Permanent Location: New Orleans, US-LA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:26
-
Description & Requirements
Maximus is currently hiring for Specialist - Medical, NP/PA to join our team.
This is a remote opportunity and contingent upon award of contract.
The Specialist will be responsible for providing independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Review assessments to determine if the correct conclusion for eligibility of services was reached by the nurse assessor.
- Collect data related to assessments and assessment outcomes.
- Examine each case for completeness, accuracy and consistency.
- Analyze UAS recommended scores in relation to nurse assessor determinations.
- Conduct scheduled home visits with the nurse assessor.
- Examines data for outliers and researches such cases.
- Develop/complete reports that track and trend activities/outcomes.
- Act as an advisor to UAS staff on all QA and compliance issues related to the UAS project.
- Attend Fair Hearing cases and prepare case packets, as required.
- Perform other duties as may be assigned by management.
- Review and provide independent medical reviews for prior authorization requests for relating to Workers' Compensation benefits (WC), Disability benefits (DB), Paid Family Leave (PFL) benefits, Volunteer Firefighters' benefits, and Volunteer Ambulance Workers' benefits.
- Evaluate Level 3 prior authorization requests (PARs) for medical services and goods including but not limited to all PAR types (Medication, Confirmation, Variance, Special Services, Durable Medical Equipment), all New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria for all medical services, medications, medical devices contemplated therein, or requests for variances for medical treatment not addressed or recommended.
- Review all documentation submitted with the PAR, including the Level I and Level II responses.
- Review all information in the electronic case folder which is relevant and necessary for proper review of the request, in accordance with the previously provided instructions and training.
- Render medical/clinical determinations based on professional experience that is clear, professional and grammatically correct.
- Audit complex determinations for other clinical reviewers utilizing clinical expertise, medical records, New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Conduct appropriate training to reviewers in using and applying the New York State Workers' Compensation Medical Treatment Guidelines and Drug Formulary criteria.
- Ability to perform comfortably in a fast-paced, production and deadline-oriented work environment.
- Provide written clinical rationales for ...
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Type: Permanent Location: Baton Rouge, US-LA
Salary / Rate: Not Specified
Posted: 2025-04-30 08:44:26
