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General information
Job Posting Title
Clinical Reviewer LPN - (Remote)
Date
Thursday, September 10, 2026
City
Remote
Country
United States
Working time
Full-time
Description & Requirements
Maximus is seeking a Clinical Reviewer (LPN) supporting the Colorado HMA (Health Maintenance Activities) Review Program. This role requires completion of desk based clinical reviews to determine appropriateness of recommended services, supports program goals and service level agreements (SLAs). The reviewer must participate in all required trainings and meetings, in addition to other tasks as required by their supervisor.
Work Schedule: This position is scheduled Monday through Friday from 8:00 a.m. to 5:00 p.m. Mountain Time with some weekend coverage required based on business needs.
Why Maximus?
- Work/Life Balance Support - Flexibility tailored to your needs!
- Competitive Compensation -Bonuses based on performance included!
- Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance.
- Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
- Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage.
- Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
- Recognition Platform - Acknowledge and appreciate outstanding employee contributions.
- Tuition Reimbursement - Invest in your ongoing education and development.
- Employee Perks and Discounts - Additional benefits and discounts exclusively for employees.
- Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs.
- Professional Development Opportunities-Participate in training programs, workshops, and conferences.
- Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees.
Essential Duties and Responsibilities:
- Review requests for services, including admissions, discharges, and continued stays for adherence to clinical criteria, state and federal policy, and contract requirements involving broad clinical complexity and variability; apply subject matter expertise to ensure consistency and drive quality outcomes; and escalate exceptions to policies.
- Issue approvals, denials, or recommendations based on contract requirements; ensure quality, consistency, and adherence to clinical and regulatory standards across cases.
- Identify the need for additional clinical documentation or consultation and analyze information gaps to support accurate and timely determinations.
- Complete accurate documentation of review activities within contract systems.
- Communicate and collaborate with providers, individuals and their designees, state workers, and external stakeholders to clarify requirements, resolve issues, and support program outcomes.
- Provide guidance, coaching, training and quality review for team members; identify opportunities to improve review processes and consistency.
- May meet with external clients to confirm and update clinical guidelines that must be followed internally.
- May write high-quality, fully substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation, including completing the summary of findings.
Minimum Requirements
- Specific clinical license and experience requirements based on contract requirements.
- Associate degree in Nursing
- An active LPN license in the state of Colorado or a compact license is required
- Minimum 2 years of experience working with people with complex disabilities, including pediatric and geriatric populations
- Familiarity with Home and Community Based Services waivers (HCBS)
- Proficiency in Microsoft Office applications
Preferred Requirements:
- Prior experience conducting document-based reviews
- Excellent written and communication skills
- Previous experience working remotely
- Prior experience conducting document-based reviews
Home Office Requirements:
- 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
- Private and secure workspace
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
$
29.86
Maximum Salary
$
35.48