Consultant - Medical (Case Reviewer 2)

Maximus; Seattle (WA); Remote; USD 68,000 - 72,000; Full time

Job summary

An established industry player is seeking a detail-oriented Consultant to join their remote team. In this role, you'll review and certify medical cases, ensuring compliance with established guidelines. You will leverage your medical knowledge and consulting experience to make informed determinations and contribute to special projects. The company values diversity and offers a competitive salary along with comprehensive benefits, making it an ideal opportunity for professionals looking to make a meaningful impact in the healthcare sector.

Benefits

Health insurance

Retirement plans

Paid holidays

Remote work equipment

Qualifications

• 3-5 years of relevant consulting experience or equivalent professional experience.
• Flexibility to work more than 40 hours/week post-training.

Responsibilities

• Review WCMSA case submissions and provide clinical rationales.
• Monitor review timeliness to meet production and quality standards.
• Audit complex determinations for compliance.

Skills

Medical knowledge

ICD-9/10 coding

CPT coding

Workers' compensation fee schedules

HIPAA compliance

Education

Bachelor's degree

RN licensure

Job description

Job Description & Requirements

Maximus is currently hiring for a Consultant - Medical (Case Reviewer 2) to join our WCRC team.

This is a remote opportunity.

Responsibilities

1. Review WCMSA case submissions in support of the Workers' Compensation Review Contractor.
2. Review cases, summarize facts, assess issues, and certify or non-certify requested treatments.
3. Provide written clinical rationales for CA Workers Compensation cases.
4. Organize and identify all medical records for CA workers' comp cases.
5. Monitor review timeliness to meet standards.
6. Meet production and quality standards consistently.
7. Perform special projects like legal and medical research.
8. Improve CA IMR projects or other initiatives.
9. Become a subject matter expert using job aids and learning tools.
10. Review and evaluate proposed Medicare set-aside arrangements.
11. Ensure documentation is complete before review.
12. Render medical determinations based on experience and implement CMS policies.
13. Audit complex determinations for compliance.
14. Other duties as assigned.

Minimum Requirements

• Bachelor's degree with 3-5 years of relevant consulting experience, or relevant professional experience in lieu of degree.
• RN licensure preferred.
• Ability to commit to a two-week training (9:00am - 6:00pm EST, Mon-Fri).
• Flexibility to work more than 40 hours/week post-training.
• Medical knowledge with experience in medical terminology, ICD-9/10, CPT codes, and workers' compensation fee schedules.

Preferred Skills and Qualifications

• Medicare Set-Aside Certified Consultant (MSCC) certification.
• Experience in Medical/Utilization Review and Medicare Set-Aside Arrangements.
• Knowledge of HCPCS coding, Medicare guidelines, anatomy, physiology, pharmacology, clinical guidelines, and state-specific workers' comp rules.
• Understanding of HIPAA and healthcare confidentiality.

Home Office Requirements

• Internet speed of 20 Mbps or higher, 50 Mbps for shared connections.
• Minimum 5 Mbps upload speed.
• Connectivity via Wi-Fi or Ethernet to the home router.
• Private work area and reliable power source.
• Reside in the Continental US.

Additional Information

Maximus provides equipment for remote work. Salary ranges from $68,000 to $72,000 annually, based on experience and other factors. Benefits include health insurance, retirement plans, paid holidays, and more. Maximus is an equal opportunity employer and values diversity.