Description:
Maximus is currently hiring for a Nurse Manager - Appeals to join our State East - Appeals team. The Manager is responsible for overseeing a team of clinical staff who are responsible for appeals and case review.
- An active, unrestricted RN License is required for this position*
Essential Duties and Responsibilities:
- Serve as the lead content knowledge expert concerning the review and research of provided clinical information.
- Perform clinical case reviews and consultations
- Provide direct supervision to assigned team of nursing and/or other clinical staff
- Provide subject matter expertise related to medical necessity and level of care criteria and application thereof
- Provides education and clinical training to staff in area of expertise
- Performs other related duties as assigned.
- Develop, monitor, and use quality control procedures and audit criteria to ensure consistent application of contractual requirements and established policies and procedures.
Minimum Requirements
- Current Registered Nurse (RN) license valid in the state of practice is required
- Bachelor's degree and 5 years of experience or equivalent combination of education and experience required
- Minimum of 5 years of clinical experience
- Minimum 1 year supervisory experience preferred
- Healthcare appeals experience preferred.
- Home Office Requirements:
- Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net )
- Minimum 5mpbs upload speed
- Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US