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Posted: Friday, September 1, 2017 3:21 AM

The Consultant is responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.Perform independent review of favorable and partially favorable Administrative Law Judge determinations in accordance with the Part A, Part B, and DME Medicare regulations to determine if there are errors in the application of law or evidenceResearch issues using federal law, federal regulations and CMS policySummarize policy legal issues to be submitted to the Medicare Appeals CouncilWork directly with federal government entities and contractors in regards to appeals and other special initiatives as requests from other government entities dictateMonitor timeliness of reviews to ensure timely effectiveness in order to meet required CMS standardsCoordinate and assist in the development and maintenance of written procedures for consistency of reviews and training of new personnelPerform 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 necessaryMeet or exceed all performance standards established for this position and departmentPerforms other duties as assigned by leadershipRegistered Nurse degree with active license in SCBSN preferred2 years of related experience requiredExperience in general medical care of patients preferredKnowledge of health regulations, guidelines and coverage issuesKnowledge of statistical terminology and use of statisticsExcellent organizational, written, and verbal communication skillsAbility to perform comfortably in a fast:paced, deadline:oriented work environmentAbility to work as a team member, as well as independentlyFour year nursing degree preferred; Medicare Medical Review or appeals experience in Medicare Part A, Part B and/or DME preferred; Experience in geriatric or general medical care of patients preferredA committed and diverse workforce is our most important resource.MAXIMUS is an Affirmative Action/Equal Opportunity Employer.MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.


• Location: Columbia

• Post ID: 22830642 columbia is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2017