Location: Bronx,NY, USA
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.
-Enter assessment data into the UAS-NY online application and transmit, as required.-Code the UAS assessment correctly based on training and guidelines in the UAS-NY Community Health Assessment Reference Manual.-Review non-qualified assessments with the Clinical Quality Assurance Department.-Maintain a comprehensive working knowledge of community resources, payor requirements, and network services for target population.-Maintain updated knowledge of the UAS-NY assessment process.-Review consumer medical documentation and/or health referral forms, as relevant to the case.-Document any concerns, conflicting information, other issues that surface during the evaluation process.-Perform other duties as many be assigned by the Senior Manager or other project management.Minimum Requirements-Active RN license required.
Minimum 2 years clinical experience required with RN license.
-2+ years RN experience in-home care.-Active and unrestricted RN license in the state of New York.-Ability to travel locally.-Reliable form of transportation may include ride-sharing options.Preferred Qualifications-Prior experience using the UAS-NY Community assessment tool.Home Office Requirements-Maximus provides company-issued cellphone.-Maximus provides company-issued computer equipment.-Reliable high-speed internet service with 100 Mbps download speed (www.speedtest.net)-Private and secure home office workspace.#NYMC #NYMCRegisteredNurse #NYMCRN #maxPriorityEEO StatementActive military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We're proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A 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.Pay TransparencyMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.Minimum Salary$107,000.00Maximum Salary$118,000.00