Consultant - Nurse (remote)

Maximus is currently hiring for a Consultant - Nurse to join our QIC Part B team. This is a remote opportunity. *Position is contingent upon contract award*

Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations. Render determinations for cases assigned. Resolve all other technical issues within reconsideration assigned. Review cases or sites assigned to determine and summarize facts and assess any issues identified. 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. Perform other duties as assigned by management. Render medical necessity determinations for Medicare Part B QIC reconsideration cases assigned. Resolve all other technical issues within Medicare Part B QIC reconsiderations assigned Review cases to determine and summarize facts of each case assigned and assesses issues involved in the case Review file to determine whether all relevant information has been submitted Research issues using federal and state law, federal and state regulations, relevant contract law and other sources as defined by the client contract 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 Meet or exceed all performance standards established for this position Perform other duties as assigned by management