Clinical Reviewer LPN – (Remote)

Maximus; Santa Fe (NM); Remote; USD 37,000 - 41,000; Full time

Benefits offered by this job

Work/Life Balance

Bonuses

Insurance Coverage

401K Matching

PTO & Holidays

Wellness Resources

Recognition Platform

Tuition Reimbursement

Employee Discounts

Wellness Program

Professional Development

Licensure Reimbursement

Job summary

Maximus is seeking a Licensed Practical Nurse (LPN) to serve as a Clinical Reviewer for the Illinois PASRR program. This fully remote role involves reviewing clinical documentation, conducting Level I PASRR screenings, and evaluating behavioral health and medical information to guide clinical decisions.

You will collaborate with healthcare providers, monitor screening activities, and ensure HIPAA compliance and contract standards. Strong clinical judgment and attention to detail are essential.

Qualifications

• Current and active LPN license in IL or Compact license.
• Minimum 2 years of medical nursing and/or mental health experience.
• Proficiency in MS Office applications.

Responsibilities

• Review requests for admissions, discharges, and continued stays for adherence to clinical criteria and contract requirements.
• Issue approvals, denials, or recommendations based on contract requirements.
• Identify need for additional clinical documentation or consultation and analyze information gaps.
• Complete accurate documentation of review activities in contract systems.
• Communicate with providers, individuals and their designees, or state workers as required.
• Serve as an internal resource to team members within established processes.
• May write high-quality, fully substantiated clinical determination reports and summaries.

Skills

LPN license

Medical nursing

Mental health

Attention to detail

Communication

Education

High School Diploma

Tools

MS Office

Job description

Join Maximus as a Clinical Reviewer (LPN) and play a vital role in supporting the Illinois SALT (Screening Assessment for Long-Term Settings) program. In this fully remote position, you will help ensure individuals receive the appropriate level of care by reviewing clinical documentation, conducting Level I PASRR screenings, and evaluating behavioral health, intellectual/developmental disability, and medical information to support informed clinical decisions. The role involves reviewing screening cases, coordinating documentation with providers, identifying situations requiring further evaluation, and ensuring compliance with HIPAA and program standards.

As a member of a collaborative clinical team, you will partner with healthcare providers, monitor screening activities, recognize trends, and contribute to quality outcomes for individuals requiring long-term care services. If you are a licensed nurse with strong clinical judgment, attention to detail, and a passion for improving healthcare outcomes, we encourage you to apply.

Schedule: Tuesday through Saturday, 10:00 AM to 7:00 PM CT

About The Program:

We have contracted with the State of Illinois Department of Healthcare and Family Services (HFS) to manage the assessment process for Preadmission Screening and Resident Review (PASRR) Level I screens and completing Level II Serious Mental Illness (SMI) evaluations for individuals applying to, or residing in, Medicaid-certified nursing facilities. Other services include Follow Up Visits, admissions support for Specialized Mental Health Rehabilitation Facilities (SMHRF) and Supported Living Programs (SLP) settings and Colbert Dementia Review.

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; elevate complex and non-standard cases that are exceptions to policies.
• Issue approvals, denials, or recommendations based on contract requirements, applying judgment and analysis to interpret guidelines in non-routine 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 with providers, individuals and their designees, or state workers as required.
• Serve as an internal resource to team members within established processes.
• 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.

‘- High School Degree or equivalent required

• Current and Active Licensed Practical Nurse (LPN) license in State of Illinois or Compact license
• Minimum 2 years of experience in Medical Nursing and/or Mental Health
• Proficiency in MS Office Applications such as Outlook, Excel, Power Point, and Word

Preferred Requirements

• 4+ years of experience in Medical Nursing and/or Mental Health
• Prior Intellectual and Developmental Disabilities experience
• Prior experience with Level I PASRR screenings
• Effective communication skills and ability to follow directions
• Ability to interact courteously and effectively with a variety of people
• Ability to handle pressure and perform multiple tasks
• Must be able to (at minimum) type 35 WPM

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

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.

Minimum Salary

$26.8

Maximum Salary

$29.57