Nurse - Consultant - Maximus

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 competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.