Clinical Nurse Consultant

This is a remote opportunity.

About the role

The Clinical Nurse Consultant manages the end-to-end medical review process, ensuring cases are accurately assessed, assigned to the appropriate clinical specialty reviewer, and completed within established timelines. This role collaborates with healthcare providers, prepares case summaries and medical necessity documentation, and supports quality assurance to ensure timely and compliant review decisions. This position will require a Federal Suitability Clearance post-hire as mandated by the client.

Responsibilities

• Review favorable and partially favorable determinations in accordance with applicable regulations.
• Render determinations for assigned cases.
• Resolve technical issues within reconsideration assigned.
• Review cases or sites assigned to determine and summarize facts and assess any issues identified.
• Perform special projects such as general legal research, medical research, drafting proposal sections, or acting as a liaison for specific projects.
• Perform other duties as assigned by management.
• Review medical records and identify the appropriate clinical specialty required for review.
• Conduct outreach to qualified reviewers.
• Assign cases in Salesforce.
• Prepare case files and complete the accompanying medical review form.
• Submit complete case files to panelists through Axway.
• Receive completed reviews from panelists and verify cited references.
• Prepare draft decisions using established templates.

Requirements

• Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
• Ability to work a schedule between the hours of 9:00am - 6:00pm EST Monday - Friday.
• Flexibility to work extended hours or weekends as business needs require.
• Ability to pass a Federal Suitability Clearance.

Preferred Qualifications

• Valid, active LPN or RN license.
• Experience working with Salesforce and/or Axway.
• Experience reviewing medical records and/or health plan regulations.

Home Office Requirements

• Internet speed of 25mbps or higher required (50 Mbps for shared internet connectivity).
• Minimum 5mbps 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 will provide equipment to use.

Pay

Annual salary range: $59,000.00 – $65,000.00.

Maximus compensation is based on various factors including job location, education, training, experience, expected quality and quantity of work, required travel, external market, and internal value analysis. 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.