Nurse Manager - Appeals

As a well-respected government contractor, we’re moving people forward by providing transformative technology services, digitally enabled customer experiences, and clinical health services that change lives. Our employees share an authentic desire to make vital services available to the public and support the mission of our customers. This is why we’re committed to creating the best employee experience possible— continuously improving our compensation offers, benefits, work environment, diversity, equity, and inclusion initiatives, and engagement events.

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*

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.