The medical professional shall be a clinician expert in the treatment of the enrollee’s medical condition and knowledgeable about the proposed treatment though recent or current actual clinical experience treating patients with similar medical condition(s).
Notwithstanding any other provision of law, the medical professional shall hold a non-restricted license in any state of the United States, and for physicians a current certification by a recognized American Medical Specialty Board in the area or areas appropriate to the condition or treatment under review.
Expert reviewers are 100% remote and reviewers will complete cases on their own computer. This is a 1099 Independent Contractor position. These are Medial Necessity or Experimental/Investigational reviews, and the reviewers must be unbiased and have no relationship with the Managed Healthcare Plan or the enrollee. Independent medical reviews can be one of three types: Medical Necessity, Experimental/ Investigational and Emergency.
The project team will provide training once the provider has completed the Maximus Onboarding process.
Minimum Qualifications: • Active license • 24 hours of direct patient care per week • Board Certification • 5 years experience in appropriate specialty post-residency/fellowship training (MD/DO) • 3 years experience in appropriate specialty post-training (non-MD/DO)
As a leading strategic partner to governments across the globe, Maximus helps improve the delivery of public services amid complex technology, health, economic, environmental, and social challenges. With a deep understanding of program service delivery, acute insights that achieve operational excellence, and an extensive awareness of the needs of the people being served, our employees advance the critical missions of our partners. Maximus delivers innovative business process management, impactful consulting services, and technology solutions that provide improved outcomes for the public and higher levels of productivity and efficiency of government-sponsored programs. For more information, visit maximus.com.
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