Clinical Reviewer Registered Nurse (Remote)

Maximus; Tysons (VA); A distancia; USD 61.000 - 72.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Retirement plan

Paid time off

Paid holidays

Descripción de la vacante

Maximus is seeking a Clinical Reviewer in Tysons, VA to evaluate requests for services, ensure compliance with clinical and governmental requirements, and issue appropriate approvals or denials. The role involves documenting activities in contract systems and communicating with providers and state personnel.

Preferred candidates have remote-work experience, strong written and verbal communication skills, and familiarity with HCBS waivers.

Formación

• Current RN license valid in the state of practice is required.
• Associate degree in Nursing.
• Minimum 2 years of clinical experience required.
• An active RN license in Colorado or a compact state is required.
• Minimum 2 years of experience with people with complex disabilities (pediatric and geriatric).
• Familiarity with HCBS waivers.

Responsabilidades

• 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.
• Provide training and/or consultation to assigned Clinical Reviewers.
• Performs other related duties as assigned.

Conocimientos

Microsoft Office

Excellent written and communication

Educación

Associate degree in Nursing

Descripción del empleo

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.
• Provide training and/or consultation to assigned Clinical Reviewers.
• Performs other related duties as assigned.

Minimum Requirements

• Current Registered Nurse (RN) license valid in the state of practice is required
• High School Degree or equivalent required
• Minimum 2 years of clinical experience required
• Associate degree in Nursing
• An active RN (Registered Nurse) 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 [e-mail] .

Minimum Salary

$44.42

Maximum Salary

$52.02