Clinical Reviewer LPN – Remote-Eligible

MAXIMUS; Lebanon (NH); Hybrid; USD 41,000 - 49,000; Full time

Job summary

Maximus seeks a qualified clinical reviewer to assess requests for services, including admissions and discharges, ensuring adherence to clinical criteria, policy, and contract requirements. You will issue determinations, request additional documentation, and document activities in contract systems.

The role emphasizes collaboration with providers and state personnel, coaching peers, and potentially updating guidelines.

Qualifications

• 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.

Responsibilities

• Review requests for services, including admissions, discharges, and continued stays for adherence to clinical criteria and contract requirements.
• Issue approvals, denials, or recommendations based on contract requirements and standards.
• Identify the need for additional documentation or consultation and analyze information gaps.
• Complete accurate documentation of review activities within contract systems.
• Communicate and collaborate with providers, state workers, and external stakeholders to clarify requirements and support program outcomes.
• Provide guidance, coaching, training and quality review for team members; improve review processes.
• May meet with external clients to confirm and update clinical guidelines.
• May write high-quality, fully substantiated clinical determination reports, including the summary of findings.

Skills

Microsoft Office

Communication skills

Education

Associate degree in Nursing

Active LPN license in CO or compact state

Job description

Maximus seeks a qualified clinical reviewer to assess requests for services, including admissions and discharges, ensuring adherence to clinical criteria, policy, and contract requirements. You will issue determinations, request additional documentation, and document activities in contract systems.

The role emphasizes collaboration with providers and state personnel, coaching peers, and potentially updating guidelines.