• Medical Consultant

    Job Locations US-CA-Folsom
    Posted Date 6 days ago(6/11/2018 3:30 PM)
    Requisition ID
    # of Openings
    Job Function
    Job Schedule
    Regular Full-Time
  • Overview

    MAXIMUS is a leading operator of government health and human services programs and has partnered with state, federal and local governments to provide critical, high quality health and human service programs to a diverse array of communities. Operating under MAXIMUS’s founding mission of Helping Government Serve the People® since 1975, MAXIMUS Federal Services is entirely focused on helping government agencies run programs cost-effectively and serve program constituents with improved outcomes. By being a responsible steward for government programs, we help the federal government deliver on its promises through our people, process and technology. Our focus is always on outcomes and results that connect citizens more effectively with government services.

    The Nurse Reviewer/ Medical Consultant is responsible for independently reviewing the medical records and application of CA Workers Compensation regulations to determine status of appeals.



    • Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments
    • May provide written clinical rationales for CA Workers Compensation cases
    • Review, organize and identify all medical records provided for CA workers comp cases
    • Monitor timeliness of reviews to ensure applicable standards are met
    • Consistently meet production and quality standards
    • Perform special projects as assigned such as legal research, general medical research, etc. There may be opportunities to work on special projects to improve CA IMR project or other special projects as assigned
    • Become a subject matter expert (SME) using job aides and learning tools


    The Ideal Candidate will Possess the Following Additional Education and Experience

    • Registered Nurse with active license required
    • Bachelor’s Degree preferred
    • Minimum two (2) years of related experience required
    • Experience in general medical care of patients preferred
    • Available during core work hours for meetings and training (11 AM- 3PM EST). Exempt production expectation may require working beyond standard hours or in excess of 40 hours per week based on project needs
    • Adapt to a dynamic environment with many changes and special projects that may require extensive, fast paced, independent learning
    • Knowledge of health regulations, guidelines and coverage issues
    • Knowledge of statistical terminology and use of statistics
    • Must possess strong analytical skills, problem solving and decision making skills
    • Excellent organizational, written, and verbal communication skills
    • Ability to work in multiple computer programs with dual screens
    • Ability to perform comfortably in a fast-paced, deadline-oriented work environment
    • Ability to work as a team member, as well as independently
    • Ability to work with little supervision

    Remote Assignment Requirements:

    • The Remote Worker will conduct daily activities and supervisor communications as if the employee were in a MFS office location
    • The Remote Worker must be accessible by phone, e-mail, IM, or voice mail within a reasonable time period during the agreed-upon work schedule
    • The Remote Worker must check e-mail, voice mail, and IM for updates through-out the agreed-upon work schedule timeframe.  The Remote Worker may not access these during non-work schedule hours.
    • The Remote Worker must have a SmartPhone with the ability to access security applications
    • Other members of the Remote Worker’s family and visitors to the Remote Worker’s home may not use MFS equipment
    • Remote Workers are responsible to make the appropriate work arrangements that maintain separation between the employee’s private life and business activities
    • An established and demonstrated safe and quiet home work environment (as defined by the Remote Worker PI Policy and the Remote Worker Privacy and Security Checklist)
    • Ability to use and maintain reliable internet service. Broadband/Cable internet is recommended with a 80 megabits download capability.


    EEO Statement

    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.


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