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RN Senior Coord - Clinical Rev in Franklin, TN at Maximus, Inc.

Date Posted: 8/17/2018

Job Snapshot

Job Description

RN current Tennessee licensure

-Conducts utilization review of medical assessor documentation related to level of care (LOC) that adheres to state-directed clinical criteria for determining medical need.
-Actively participates in appeals hearings for denied services, serving asthe State’s wittness to testify to the Choices Program Level of Care criteria. 
-Responds to questions given by attorneys, judges, and any additional hearing attendees.
-Attends and participates in scheduled contract, committee, and all-staff meetings.
-Completes other duties as required or assigned by the manager.

The Ideal Candidate will Possess the Following Additional Education and Experience
  • Minimum Associates Degree in Nursing and current Tennessee RN licensure.  A Bachelor of Science in Nursing is preferred.
  • Minimum of 3 years of Nursing experience.  Utilization review is strongly preferred.
  • May have additional training or education in area of specialization.
  • Works on assignments that are moderately difficult, requiring judgement in resolving issues.
  • Understands implications or work and makes recommendations for solutions.
  • Communicates on complex or sensitive issues or draft such responses for supervisor or team lead.
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.


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