Clinical Nurse Consultant

Maximus is currently hiring for a Clinical Nurse Consultant to join our Federal Exchange Review Process (FERP) team. This is a remote opportunity. The Consultantmanages 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. Essential Duties and Responsibilities: Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations. Render 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. 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. 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 Skills and Qualifications: Valid, active LPN or RN license. Experience working with Salesforce and/or Axway. Experience reviewing medical records and/or health plan regulations. 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 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 EEO Statement 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. Pay Transparency Maximus 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. Accommodations Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process—including accessing job postings, completing assessments, or participating in interviews,—please contact People Operations at View email address on click.appcast.io . Apply or refer using the internal links below. Join our talent community for exclusive job openings, resources, and career opportunities. #J-18808-Ljbffr Maximus