Remote Clinical Reviewer Jobs (NOW HIRING)

Description & Requirements
Maximus is hiring a Clinical Reviewer RN/LPN to support our LTSS Tennessee contract. Areas will include but are not limited to PASRR Level 1 and Katie Beckett. In this role, you will review clinical documentation and requests submitted by individuals/providers/state partners to determine appropriate level of care and prior authorization needs. You will gather any additional documentation through email, phone, and fax needed to make the level of care decision.
**This is a remote position; candidates must reside in Tennessee.
About the Program
Maximus partners with the State of Tennessee to conduct Preadmission Screening and Resident Review (PASRR)-a federally mandated process designed to d etermine whether a nursing facility is the appropriate level of care; i dentify individuals with mental illness, intellectual disabilities, or developmental disabilities and help connect individuals with the services and supports they need.
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 admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements.
- Issue approvals, denials or recommendations based on contract requirements.
- Identify need for additional clinical documentation or consultation.
- Complete documentation of activities within contract systems.
- Communicate with providers, individuals and their designees, or state workers as required.
- Performs other related duties as assigned.
Minimum Requirements
- Education and licensure requirements are based on program contract requirements and are outlined in job posting
- High School Degree or equivalent required
- Minimum 2 years of clinical experience required
- Current and valid Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in the state of Tennessee.
- Minimum of two (2) years of clinical experience in a Registered Nurse (RN) or Licensed Practical Nurse (LPN) position.
- Proficiency in Microsoft Office Suite (Word, Outlook, Excel), Adobe
- Strong clinical assessment, critical thinking, documentation skills, and the ability to apply clinical judgment accurately in a fastpaced environment.
- Strong written and verbal communication skills.
Preferred Requirements
- Experience in care management and documenting clinical reviews.
- Proficiency with electronic medical records and clinical documentation systems.
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
#ClinicalServices #LI-Remote
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
$
26.00
Maximum Salary
$
28.00