• Appeals Manager - REMOTE

    Job Locations US-NY-Pittsford
    Posted Date 1 month ago(11/9/2018 4:36 PM)
    Requisition ID
    # of Openings
    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.


    Essential Job Duties:
    Manage teams ensuring they follow MAXIMUS policies and procedures
    Administer performance management processes to include developing and implementing training plans, monitoring quality and productivity, administering corrective/disciplinary action when necessary, and administering the performance evaluation process
    Assist teams when necessary in coordination of case processing and workload adjustment
    Act as liaison for the management team with other shared services functions, including Production Services, Training, Performance Management, and Business Intelligence as necessary
    Consult with Legal Counsel, Physician Reviewers, Medical Directors, and Project Directors as necessary
    Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures
    Maintains updated knowledge of Client requirements
    Manage recruitment and hiring of staff
    Perform other duties as may be assigned by management
    Experience and Education:
    Bachelors degree from an accredited college or university required, preferred field of study in Health Services
    Clinical degree (e.g. RN, RPh, etc.) and/or an advanced degree (Masters, Doctorate, JD) preferred
    Five years’ work in team-based operations
    Experience with DME required
    Minimum of five years management experience; Or related clinical experience
    Experience working with Quality Assurance
    Demonstration of year-over-year improved efficiency and innovation
    Evidence of analytic problem-solving skills
    Excellent organizational, interpersonal, written, and verbal communication skills
    Ability to perform comfortably in a fast-paced, deadline-oriented production environment
    Ability to adapt to and be an agent of positive change in a developing work environment
    Ability to successfully execute many complex tasks simultaneously
    Ability to work as a team member, as well as independently
    Proficiency in software application including but not limited to MS Office
    Health care services management experience preferred
    ISO 9001-2008 experience preferred
    Experience in both implementation and production environments preferred

    The Ideal Candidate will Possess the Following Additional Education and Experience

    • Manages, perhaps through subordinate supervisors, the coordination of the activities of a section or department with responsibility for results, including costs, methods and staffing.
    • In some instances this manager may be responsible for a functional area and not have any subordinate employees.
    • Works on issues of diverse scope where analysis of situation or data requires evaluation of a variety of factors, including an understanding of current business trends.
    • Follows processes and operational policies in selecting methods and techniques for obtaining solutions.
    • Acts as advisor to subordinate(s) to meet schedules and/or resolve problems.
    • Develops and administers schedules, performance requirements; may have budget responsibilities.
    • Frequently interacts with subordinate employees, customers, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers and the company.
    • Often must lead a cooperative effort among members of a project team.
    • Receives assignments in the form of objectives and determines how to use resources to meet schedules and goals.
    • Provides guidance to subordinates within the latitude of established company policies.
    • Recommends changes to policies and establishes procedures that affect immediate organization(s).

    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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