Sr Coordinator - Clinical Ops, LPN (remote)

Maximus is currently hiring for a Sr Coordinator - LPN to join our QIC DME team. The Sr Coordinator - LPN is responsible for medical reviews and applying Medicare coverage criteria following project guidelines. -This is a remote opportunity. *Position is contingent upon contract award*

Responsible for reviewing documentation and/or assessments and applying clinical criteria to complete determinations, approvals or recommendations. Determine need for and obtain any additional information required to complete actions. Determine when escalation or consultation is required with supervisor, physician or related medical or related clinical discipline. Complete reports or documentation in accordance with contract requirements. Performs other related duties as assigned. Provides clinical review on Medicare Appeals reviewing clinical data and application of Medicare Law for QIC Part B Reviews cases to determine and summarize the facts of each case and assesses issues involved in the case. Render reconsideration determinations on Medicare appeals. Will utilize search engines tools to research issues using federal or law, federal regulations, and relevant CMS policies. Write the rationale rendering a determination in a clearly written letter is sent to all appropriate parties as required by the specific client contract. Ensures all data collected in a case file is accurate and enters and maintains data to related appeal computer tracking system. Performs other duties as assigned by management