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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Roanoke, US-VA
Salary / Rate: 64000
Posted: 2024-05-03 09:03:04
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Charleston, US-WV
Salary / Rate: 64000
Posted: 2024-05-03 09:03:04
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Spokane, US-WA
Salary / Rate: 64000
Posted: 2024-05-03 09:03:03
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Milwaukee, US-WI
Salary / Rate: 64000
Posted: 2024-05-03 09:03:02
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Cheyenne, US-WY
Salary / Rate: 64000
Posted: 2024-05-03 09:03:01
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Eau Claire, US-WI
Salary / Rate: 64000
Posted: 2024-05-03 09:03:00
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Lubbock, US-TX
Salary / Rate: 64000
Posted: 2024-05-03 09:03:00
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: St. George, US-UT
Salary / Rate: 64000
Posted: 2024-05-03 09:02:59
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Richmond, US-VA
Salary / Rate: 64000
Posted: 2024-05-03 09:02:58
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Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Bennington, US-VT
Salary / Rate: 64000
Posted: 2024-05-03 09:02:57
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Tysons, US-VA
Salary / Rate: 64000
Posted: 2024-05-03 09:02:57
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Dallas, US-TX
Salary / Rate: 64000
Posted: 2024-05-03 09:02:56
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Salt Lake City, US-UT
Salary / Rate: 64000
Posted: 2024-05-03 09:02:55
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Burlington, US-VT
Salary / Rate: 64000
Posted: 2024-05-03 09:02:54
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: San Antonio, US-TX
Salary / Rate: 64000
Posted: 2024-05-03 09:02:53
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Memphis, US-TN
Salary / Rate: 64000
Posted: 2024-05-03 09:02:53
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Houston, US-TX
Salary / Rate: 64000
Posted: 2024-05-03 09:02:52
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Nashville, US-TN
Salary / Rate: 64000
Posted: 2024-05-03 09:02:51
-
Create an outstanding customer experience through exceptional service.
Establish and maintain a safe and clean environment that encourages our customers to return.
Assist the department manager in reaching sales and profit goals established for the department and monitor all established quality assurance standards.
Embrace the Customer 1st strategy and encourage associates to deliver excellent customer service.
Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety of others.From one tiny Cincinnati grocery store more than a century ago, we've grown into what today is the nation's largest grocer with nearly 2,800 stores in 35 states operating under 28 different names.
As America's grocer, we take pride in bringing diverse teams with a passion for food and people together with one common purpose: To Feed the Human Spirit.
With a history of innovation, we work tirelessly to create amazing experiences for our customers, communities AND each other, with food at the heart of it all.
Here, people matter.
That's why we strive to provide the ingredients you need to create your own recipe for success at work and in life.
We help feed your future by providing the value and care you need to grow.
If you're caring, purpose-driven and hungry to learn, your potential is unlimited.
Whether you're seeking a part-time position or a new career path, we've got a fresh opportunity for you.
Apply today to become part of our Kroger family!
* Customer Service skills
* Ability to handle stressful situations
* Effective communication skills
* Knowledge of basic math
* Ability to obtain current food handlers permit once employed
* Create an outstanding customer experience through exceptional service.
* Establish and maintain a safe and clean environment that encourages our customers to return.
* Assist the department manager in reaching sales and profit goals established for the department and monitor all established quality assurance standards.
* Embrace the Customer 1st strategy and encourage associates to deliver excellent customer service.
* Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety of others.
* Create an outstanding customer experience through exceptional service.
Desired Previous Job Experience:
* Customer Service skills
* Bakery or Deli experience is helpful
* Retail experience
* Grocery Clerk (Bakery/Deli) will prepare items per customer requests using proper bakery equipment.
* Bakery/Deli Clerk should offer product samples to help customers discover new items or products they inquire about.
* Grocery Clerk (Bakery/Deli) will be able to inform customers of bakery and/or deli specials.
* Provide customers with fresh products that they have ordered and the correct portion size (or as close as possible to the amount ordered) to prevent shrink.
* Recommend de...
....Read more...
Type: Permanent Location: Rochester, US-MI
Salary / Rate: Not Specified
Posted: 2024-05-03 09:02:50
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Rapid City, US-SD
Salary / Rate: 64000
Posted: 2024-05-03 09:02:49
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Sioux Falls, US-SD
Salary / Rate: 64000
Posted: 2024-05-03 09:02:48
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Columbia, US-SC
Salary / Rate: 64000
Posted: 2024-05-03 09:02:48
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Providence, US-RI
Salary / Rate: 64000
Posted: 2024-05-03 09:02:47
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
....Read more...
Type: Permanent Location: Charleston, US-SC
Salary / Rate: 64000
Posted: 2024-05-03 09:02:46
-
Description & Requirements
Maximus is looking to fill a Nurse Consultant position.
This role includes reviewing medical records, resolving technical issues, assessing facts, and undertaking special projects such as legal and medical research, proposal drafting, and project liaison duties as directed by management.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned .
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review cases to identify and summarize key facts of each case and assess issues involved in the appeal;
- Research issues using current peer-reviewed medical literature, clinical guidelines, applicable state laws and regulations, and other sources as defined by the client contract;
- Determine the adequacy of medical records and request relevant medical records as needed;
- Review expert review findings and prepare determination letters;
- Communicate the determination in a succinct written format;
- Exercise independent judgment to ensure determination is accurate, well-supported, and defensible;
- Perform other special projects not related to a specific case, such as general medical or legal research, drafting proposal sections, or acting as a liaison for a specific project, when needed;
- Provide and holiday coverage on scheduled rotation; and
- Perform other duties as assigned by management.
- Bachelor's degree with 3 - 5 years of experience OR Associate's degree with 5 - 7 years of experience; experience in health care appeals or health care claims, preferred;
- Ability to successfully execute many complex tasks simultaneously and prioritize tasks according to urgency;
- Ability to respond to the needs of outside contacts;
- Working knowledge and use of PC, MS Word and Excel software;
- Ability to work as a part of a team as well as independently, and promote positive company relations;
- Excellent organizational, interpersonal, written, and verbal communication skills;
- Familiarity with medical terminology and/or medical record review.
- LPN Required
Home Office Requirements:
-Reliable high-speed internet service
-Minimum 25 Mpbs download speeds/50 Mpbs for shared internet connectivity
-Minimum 5 Mpbs upload speeds
Minimum Requirements
Minimum Requirements:
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- RN preferred
EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core compet...
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Type: Permanent Location: Newport, US-RI
Salary / Rate: 64000
Posted: 2024-05-03 09:02:45
