Title Case Manager, RN/LCSW (POTFF) Robust Health & Insurance Benefits – Choose from a variety of Medical, Dental, Vision, and Prescription plans, plus a partially funded HSA. You'll also have access to Life Insurance and discounts on Auto, Home, Renters, and Pet Insurance.
Essential Duties and Responsibilities:
Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
Render medical necessity determinations for Medicare State East cases assigned.
Resolve all other technical issues within Medicare reconsideration assigned.
Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
May 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.
Be the Subject Matter Expert (SME) for project.
Perform other duties as assigned by management.
Minimum Requirements:
Bachelor's degree with 5-7 years of experience consulting within designated function. Advanced degree preferred. Develop solutions to highly complex problems which require a high degree of ingenuity and innovation. Ensure solutions are consistent with organization objectives. Solutions may serve as precedent for future decisions. Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills. Develop new applications based on professional principles and theories. Viewed as expert in field within the organization.
EEO Statement:
Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics. 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. Minimum Salary $ 73,950.00 Maximum Salary $ 105,850.00
