Clinical Nurse Consultant
Maximus
Location: Grand Rapids, MI 49501, US
Employment Type: FULL_TIME
Industry: Advertising and Public Relations
Occupational Category: 13-0000.00 – Business and Financial Operations
Posted: Tuesday, 11 August 2026
Valid Through: Thursday, 10 September 2026
Job Description
Maximus is hiring a Clinical Nurse Consultant in Grand Rapids, MI. This is a full-time position.
Essential Duties and Responsibilities:
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9: 00am - 6: 00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
- Must have a smartphone which will be required to log into Maximus systems
EEO Statement
Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
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.
Accommodations
Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews, -please contact People Operations at applicantaccom@maximus.com.
Minimum Salary
$
59, 000.00
Maximum Salary
$
65, 000.00
- Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations.
- Render determinations for cases assigned.
- Resolve all other technical issues within reconsideration assigned.
- Review cases or sites assigned to determine and summarize facts and assess any issues identified.
- Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Perform other duties as assigned by management.
- Review medical records and identify the appropriate clinical specialty required for review.
- Conduct outreach to qualified reviewers.
- Assign cases in Salesforce.
- Prepare case files and complete the accompanying medical review form.
- Submit complete case files to panelists through Axway.
- Receive completed reviews from panelists and verify cited references.
- Prepare draft decisions using established templates.
Minimum Requirements
- Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience.
- Ability to work a schedule between the hours of 9: 00am - 6: 00pm EST Monday - Friday.
- Flexibility to work extended hours or weekends as business needs require.
Preferred Skills and Qualifications:
- Valid, active LPN or RN license.
- Experience working with Salesforce and/or Axway.
- Experience reviewing medical records and/or health plan regulations.
Please note: For this position Maximus will provide equipment to use.
Home Office Requirements:
- Internet speed of 25mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net)
- Minimum 5mpbs upload speed
- Connectivity to the internet via Category 5 or 6 ethernet patch cable to the home router
- Private and secure work area and adequate power source
- Must currently and permanently reside in the Continental US
- Must have a smartphone which will be required to log into Maximus systems
EEO Statement
Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.
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.
Accommodations
Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews, -please contact People Operations at applicantaccom@maximus.com.
Minimum Salary
$
59, 000.00
Maximum Salary
$
65, 000.00
Education Requirements
high school
Skills
Please see the job description for required or recommended skills.
Benefits
Please see the job description for benefits.
Index requested: 08/11/2026 03:23:36 • Indexed: 08/11/2026 03:23:36