Maximus is currently seeking a Clinical Adjudicator, RN to join our QIC Part A West team. This is a remote opportunity. The Clinical Adjudicator is responsible for reviewing Medicare Part A appeals. This position will require a federal suitability clearance post-hire as mandated by the client.

Essential Duties and Responsibilities:

• Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
• Render medical necessity 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. Minimum Requirements
• Bachelor's degree required
• Active RN license required.
• Minimum 2 years clinical experience required with RN license.
• Ability to commit to a training schedule of 8:00am
• 4:30pm EST Monday
• Friday.
• Strong written communication skills.
• Experience with medical records preferred.

Please note:

For this position Maximus will provide equipment to use.

Home Office Requirements:

• Internet speed of 25mbps 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 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
• Must have a smartphone which will be required to log into Maximus systems 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. Minimum Salary $70,000 Maximum Salary $75,000