Clinical Reviewer LPN - (Remote)

Maximus; Tysons (VA); Remote; USD 37,000 - 41,000; Full time

Benefits offered by this job

Company-provided equipment

Remote work environment

Job summary

Maximus is seeking a licensed practical nurse to review services requests, patient admissions, discharges, and continued stays against clinical criteria and contract requirements. This role involves analysis, documentation, and timely determinations to support providers and state agencies.

Preferred candidates have 4+ years in Medical Nursing or Mental Health and strong MS Office skills. The position offers home-office options with required secure workspace and reliable internet access.

Qualifications

• 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

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.
• 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

Skills

Effective communication

Education

High School degree or equivalent

Tools

MS Office

Job description

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; escalate 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 WordPreferred 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 WPMHome 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 workspaceEEO StatementMaximus 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 TransparencyMaximus 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.AccommodationsMaximus 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 [e-mail] .Minimum Salary$26.80Maximum Salary$29.57