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Clinical Adjudicator Supervisor - DME in Pittsford, NY at Maximus, Inc.

Date Posted: 5/4/2018

Job Snapshot

Job Description

MAXIMUS is a leading operator of government health and human services programs and has partnered with state, federal and local governments to provide critical, high quality health and human service programs to a diverse array of communities. Operating under MAXIMUS’s founding mission of Helping Government Serve the People® since 1975, MAXIMUS Federal Services is entirely focused on helping government agencies run programs cost-effectively and serve program constituents with improved outcomes. By being a responsible steward for government programs, we help the federal government deliver on its promises through our people, process and technology. Our focus is always on outcomes and results that connect citizens more effectively with government services.

REMOTE OPPORTUNITY - Supervise the daily operations of clinical work team supporting Durable Medical Equipment cases. Job duties include performance monitoring, performance appraisals, training and staff hiring, disciplinary action as needed, maintaining processes and procedures for the department. Serves as subject matter expert regarding the review and research of provided clinical appeals review.

Responsibilities
  • Establish work procedures and standards to improve efficiency and effectiveness of assigned operations; provide review annually or more frequent to assure continuous improvement of work processes
  • Compose performance evaluations for bonuses and annual performance reviews
  • Maintain effective interdepartmental relationships
  • Determine performance levels of team members; quality review of team work; workload product
  • Coach and mentor team members toward achieving individual and business goals. 
  • Lead staffing process to include interview and recommend applicants for hire
  • Monitor workload and coordinate schedules
  • Ensure cases are completed timely, are distributed to appropriate medical expertise, and that quality measures are met
  • Review and understand contract scope and requirements and communicate pertinent program updates in a timely manner

  • Provide disciplinary action in accordance to company and project guidelines, and complete and deliver performance warnings as applicable

  • Provide Manager with updates on all issues regarding quality, training, policy, procedures, staff issues, case determination and appeals activity
  • Perform other duties as assigned by management

The Ideal Candidate will Possess the Following Additional Education and Experience
  • Associates Degree required; Bachelors degree preferred
  • Registered Nurse with an active license required
  • Supervisory experience required; two or more years experience preferred 
  • Knowledge of clinical appeals process required
  • Ability to sort, file, type and process material in an expeditious manner
  • Experience with medical records identification
  • Experience using imaging equipment, a personal computer and other office equipment Experience conducting computer searches
  • Excellent organizational, interpersonal, written and verbal communication skills
  • Ability to perform comfortably in a fast-paced, deadline-oriented work environment
  • Ability to successfully execute many complex tasks simultaneously
  • Ability to work as a team member, as well as independently
EEO Statement EEO Statement
Active 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.