-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Richmond, US-VA
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:19
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Bennington, US-VT
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:19
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Roanoke, US-VA
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:18
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Tysons, US-VA
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:17
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Seattle, US-WA
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:17
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: San Antonio, US-TX
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:16
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Burlington, US-VT
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:15
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: St. George, US-UT
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:15
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Lubbock, US-TX
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:14
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Dallas, US-TX
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:12
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Salt Lake City, US-UT
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:12
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Nashville, US-TN
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:11
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Houston, US-TX
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:11
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Sioux Falls, US-SD
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:10
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Rapid City, US-SD
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:09
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Memphis, US-TN
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:09
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Philadelphia, US-PA
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:08
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Providence, US-RI
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:07
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Columbia, US-SC
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:07
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Charleston, US-SC
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:06
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Pittsburgh, US-PA
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:06
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Newport, US-RI
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:05
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Columbus, US-OH
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:04
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
....Read more...
Type: Permanent Location: Portland, US-OR
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:04
-
Description & Requirements
Maximus is currently hiring for a Director - Appeals (Health Insurance, Disability, Workers Compensation) to join our team.
This is a remote opportunity and contingent upon award of contract.
The Director will be responsible for managing a portfolio of programs.
*
*
*Please note that this position is contingent upon contract award
*
*
*
Essential Duties and Responsibilities:
- Act as the primary contact for the state client
- Ensure program operations are in compliance with all applicable requirements of the contract, as well as State and federal regulations.
- Ensure goals and objectives are established by Project Manager that support the overall Project strategies.
- Oversee all project administrative operations including budget, financial controls, and human resources.
- Plan, develop and schedule priorities for achieving operational and performance goals.
- Review management, productivity, and financial reports and studies to ensure program objectives are met.
- Participate in internal audits, research studies, forecasts, and modeling exercises to support Project direction and guidance.
- Manage operational managers, to include performance appraisals, mentoring, and professional/development guidance.
- Demonstrate a high level of dedication and proactive leadership in meeting corporate goals and program objectives.
- Perform other duties as assigned by management.
- Medical Necessity Reviews: Conduct reviews of clinical services to determine medical necessity based on established guidelines and criteria.
- Compliance: Ensure all reviews comply with state-specific workers' compensation regulations and standards
- Case Management: Collaborate with healthcare providers, claims adjusters, and other stakeholders to manage cases effectively.
- Documentation: Maintain accurate and detailed records of all reviews and decisions made.
- Communication: Provide clear and concise communication to healthcare providers regarding review outcomes and recommendations.
- Education: Educate providers and staff on workers' compensation guidelines and utilization review processes.
- Quality Assurance: Participate in quality assurance activities to ensure the integrity and accuracy of the review process.
Minimum Requirements
- Bachelor's degree in relevant field of study and 10+ years of relevant professional experience required.
- BA, BS, Registered Nurse (RN) with a valid nursing license or Masters or JD.
- Experience in workers' compensation, utilization review, or related fields preferred
- Strong analytical, communication, and organizational skills.
Proficiency in medical terminology and clinical guidelines.
- Relevant certifications such as CCM, COHN, or CRRN may be required.
- Knowledge of workers' compensation laws and regulations
- Experience with New York State Workers' Compensation Guidelines (MTGs), New York State Workers' Compensation Board Drug Formulary (Formulary), New York State Workers' Compensation Fee Schedules ...
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Type: Permanent Location: Oklahoma City, US-OK
Salary / Rate: Not Specified
Posted: 2025-04-09 08:35:03
