RN Case Manager, Military & Family Support Services

🔥 7 hours ago

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Maximus

WebsiteLinkedInAll Job Openings

10,000+ employees

🏛️ Government

🏥 Healthcare

💼 Consulting

💰 $7.9M Post-IPO Equity - Maximus on 2010-12

Government • Healthcare • Consulting

Maximus is a public-sector services firm that partners with government agencies to modernize and operate programs across health, human services, defense, national security, and civilian agencies. The company combines technology (AI, analytics, cloud, cybersecurity), omnichannel contact center and eligibility/enrollment systems, clinical and Medicaid enterprise services, and consulting and program-delivery capabilities to improve citizen experience and program outcomes. Backed by decades of government experience and scale, Maximus supports federal, state, and local clients with human-centered operational support and end-to-end digital modernization.

📋 Description

• Review favorable and partially favorable determinations in accordance with applicable regulations • Render medical necessity determinations for assigned Medicare State East cases • Resolve technical issues within assigned Medicare reconsideration cases • Review cases, summarize case facts, and assess issues involved • Conduct general legal or medical research, draft proposal sections, or act as a project liaison when needed • Serve as the project Subject Matter Expert (SME) • Coordinate services, patient care, and documentation pathways for service members and their families • Liaise between military and civilian medical and non-medical agencies to support continuity of care • Conduct assessments, care planning, and evaluation to promote optimal health and successful transitions back to duty or into the civilian community • Perform other duties assigned by management

🎯 Requirements

• Active RN license • Minimum two-year nursing degree from an accredited institution • Minimum 2 years of nursing and/or case management experience • Bachelor's degree with 5–7 years of experience consulting within the designated function • Advanced degree preferred • Case manager certification from a recognized certifying organization, or ability to obtain certification within one year of hire • Active secret clearance at minimum • Demonstrated ability to understand diagnoses and optimize client function and self-care • Knowledge of client education principles and complex medical, psychosocial, and financial problem management • Knowledge of VA/DoW Clinical Practice Guidelines • Knowledge of healthcare financial environment and population-health fiscal stewardship • Research tools for critically evaluating practices, opportunities, and outcomes • Knowledge of pharmaceuticals, including effects, side effects, and complications • Knowledge of community resources, client entitlements, and benefit eligibility • Ability to use utilization review criteria and identify quality and risk-management issues • Ability to use information systems, technology, computers, and software for data collection, tracking, trending, analysis, and presentations • Professional oral and written communication skills • Team coordination, facilitation, and communication skills • Reliable high-speed internet service • Minimum 20 Mbps download speed, or 50 Mbps for shared internet connectivity • Minimum 5 Mbps upload speed • Master's degree in Social Work (MSW) preferred • Licensed Clinical Social Worker (LCSW) licensure preferred

🏖️ Benefits

• Flexibility designed to support work/life balance • Medical, Dental, Vision, and Prescription plans • Partially funded HSA • Life Insurance • Discounts on Auto, Home, Renters, and Pet Insurance • 401(k) Retirement Savings Plan with Company Match • PTO • Paid holidays • Extended sick leave • Short- and Long-Term Disability coverage • Employee Assistance Program (EAP) • Employee recognition platform • Tuition Reimbursement opportunities • Employee discounts and additional employee-only benefits • Wellness programs and resources • Training programs, workshops, conferences, and ongoing learning opportunities • Maximus covers costs associated with renewing required licenses and certifications • Company-issued computer equipment