• Consultant - Nurse

    Job Locations US-SC-Columbia
    Posted Date 4 weeks ago(3/21/2019 2:08 PM)
    Requisition ID
    # of Openings
    Job Schedule
    Regular Full-Time
  • Responsibilities

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

    The Ideal Candidate will Possess the Following Additional Education and Experience

    - Perform independent review of favorable and partially favorable Administrative Law Judge determinations in accordance with the Part A, Part B DME Medicare regulations to determine if there are errors in the application of law or evidence
    - Research issues using federal law, federal regulations and CMS policy
    - Summarize policy legal issues to be submitted to the Medical Appeals Council
    - Work directly with federal government entities and contractors in regards to appeals and other special initiatives as requests from other government entities dictate
    - Monitor timeliness of reviews to ensure timely effectiveness in order to meet required CMS standards
    - Coordinate and assist in the development and maintenance of written procedures for consistency of reviews and training of new personnel
    - Perform other duties as assigned by leadership

    - Registered Nurse active in SC
    - Knowledge of Medicare regulations, guidelines and coverage issues preferred; Knowledge of statistical terminology and use of statistics preferred; Knowledge of claims processing software preferred
    - Four year nursing degree preferred Medicare medical review or appeals experience preferred;
    - Experience with Medicare work in Part A, Part B and DME preferred;
    - Experience in geriatric or general medical care of patients preferred
    - Ability to multiple screens
    - Proficiency in Microsoft office

    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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