Utilization review nurse Jobs in Richmond, VA

Description & Requirements Maximus is currently hiring a Lead Coordinator - Clinical Review to support the Independent Medical Review (IMR) program. What You Will Receive :

• Work / Life Balance Support - Flexible work arrangements tailored to your needs!
• Competitive Compensation - Performance-based bonuses included!
• Comprehensive Insurance Coverage - Medical, Dental, Vision, Prescription, HSA, Life Insurance, and discounts on Auto, Home, Renter's, and Pet Insurance.
• Future Planning - 401K Retirement Savings plan with Company Matching.
• Paid Time Off Package - PTO, Holidays, Extended Sick Leave, and Short / Long-Term Disability coverage.
• Holistic Wellness Support - Employee Assistance Program (EAP) for physical, emotional, and financial well-being.
• Recognition Platform - Celebrate outstanding employee contributions.
• Tuition Reimbursement - Invest in your ongoing education and professional growth.
• Employee Perks and Discounts - Exclusive benefits and discounts for employees.
• Maximus Wellness Program & Resources - Access a variety of wellness programs designed for your needs.
• Professional Development Opportunities - Participate in training programs, workshops, and conferences. Essential Duties and Responsibilities : -Review medical documentation to ensure sufficiency to allow for completion of clinical summary template - Complete clinical summary template - Review requested treatments to ensure accurate entry - Review expert specialty designation for accuracy; escalate case for any questions / concerns outside normal case processing - Perform other duties as assigned
• Minimum Requirements : - High School Degree and 2+ years clinical experience required; Associate's Degree preferred or equivalent combination of education or experience - Current Licensed Practical Nurse (LPN) OR Current Registered Nurse (RN) licenses valid in the state of practice is required - Minimum 1 year of clinical experience required - Proficient understanding and experience with Microsoft products; Word, Excel, PowerPoint, Outlook required - Excellent organizational, written, and verbal communication skills - Ability to quickly learn and proficiently use multiple project-related computer applications - Ability to multi-task and quickly adapt and perform in a fast-paced work environment. Preferred Qualifications - Prior experience in Utilization Management - Knowledge of health regulations, guidelines, and coverage issues Home Office Requirements - Candidates must have their own cell phone. - Maximus provides company-issued computer equipment - Reliable high-speed internet service - Minimum 20 Mpbs download speeds / 50 Mpbs for shared internet connectivity - Minimum 5 Mpbs upload speeds #NYMC #LI-Remote 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. 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. Minimum Salary $ 31.75 Maximum Salary $ 31.75