Clinical Reviewer (Remote)

Maximus; Dallas (TX); Remote; Full time

Job summary

Maximus is seeking a Clinical Reviewer for the Colorado PASRR Program. This remote role involves conducting clinical reviews, ensuring compliance with guidelines, and working collaboratively within a team. The position offers competitive compensation and comprehensive benefits.

Benefits

Work / Life Balance Support

Competitive Compensation

Comprehensive Insurance Coverage

401K Retirement Savings plan

Paid Time Off Package

Holistic Wellness Support

Tuition Reimbursement

Professional Development

Licensures and Certifications coverage

Qualifications

• At least 1 year of clinical experience required.
• Preferred licensure: LPN, RN, LCSW, or related.

Responsibilities

• Review requests for services ensuring adherence to clinical criteria.
• Issue approvals, denials, or recommendations based on contract requirements.
• Complete documentation within contract systems.

Skills

Data collection

Problem-solving

Analytical skills

Communication

Interpersonal skills

Customer service

Organizational skills

Education

High School Degree

Master's in Social Work

Tools

Microsoft Office Suite

Job description

Description & Requirements Maximus is seeking a dedicated and detail-oriented Clinical Reviewer to support the Colorado PASRR Program. In this remote role, you will be responsible for conducting a clinical review of Level I PASRR screens, evaluating the completed screen, making determinations regarding an individual's need for a more comprehensive PASRR assessment, and ensuring compliance with state and federal guidelines.

Program Overview

Maximus is contracted with the Colorado Department of Health Care Policy and Financing to manage the statewide CO PASRR program. Starting July 2025, we will manage submissions of all Level I PASRR referrals and status changes, conduct clinical reviews to determine if a person has a known or suspected PASRR condition (SMI, ID, or related condition), and complete comprehensive person-centered Level II assessments. This role involves working remotely as part of a collaborative team, focusing on the clinical review process to identify PASRR conditions.

Why Maximus?

• Work / Life Balance Support - Flexibility tailored to your needs!
• Competitive Compensation - Bonuses based on performance included!
• Comprehensive Insurance Coverage - Medical, Dental, Vision, Prescription, and partially funded HSA. Life insurance and discounts on Auto, Home, Renter's, and Pet insurance.
• Future Planning - 401K Retirement Savings plan with Company Matching.
• Paid Time Off Package - PTO, Holidays, extended sick leave, Short and Long Term Disability coverage.
• Holistic Wellness Support - Resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
• Recognition Platform - Acknowledge and appreciate outstanding contributions.
• Tuition Reimbursement - Support for ongoing education and development.
• Employee Perks and Discounts - Additional benefits and discounts for employees.
• Wellness Programs - Access to various wellness initiatives.
• Professional Development - Training programs, workshops, and conferences.
• Licensures and Certifications - Maximus covers expenses for renewing licenses and certifications.

Essential Duties and Responsibilities

• Review requests for services, including admissions, discharges, and continued stays, ensuring adherence to clinical criteria, policies, and requirements.
• Issue approvals, denials, or recommendations based on contract requirements.
• Identify need for additional documentation or consultation.
• Complete documentation within contract systems.
• Communicate with providers, individuals, designees, or state workers as needed.
• Perform other related duties as assigned.

Required Skills / Abilities

• Knowledge of community support programs, long-term care assessment, and level of care in medical or behavioral health.
• Understanding of medical/behavioral health diagnoses and medications.
• Data collection, problem-solving, and analytical skills.
• Excellent communication, interpersonal, and customer service skills.
• Proficiency in Microsoft Office Suite.
• Strong organizational skills and attention to detail.
• Ability to work independently in a fast-paced environment and meet deadlines.

Minimum Requirements

• High School Degree or equivalent.
• At least 1 year of clinical experience.
• Preferred licensure: LPN, RN, LCSW, or related; may be required based on contract.
• Master's in Social Work, Mental Health, or related field, or RN with psychiatric experience.
• 1-2 years working with individuals with SMI or chronic medical conditions.
• Experience conducting mental health assessments or clinical reviews.

Preferred Requirements

• Strong written communication skills for concise documentation.
• Experience working with individuals diagnosed with IDD.

Home Office Requirements

• Company-issued computer and reliable high-speed internet (minimum 20 Mbps download, 5 Mbps upload).
• Private and secure workspace.

#ClinicalServices #COAssessorAPR #maxPriority

EEO & Pay Transparency

Maximus is an equal opportunity employer. Compensation is based on various factors including experience, education, and market conditions. Salary ranges are from $26.00 to $30.67 per hour. Benefits include health insurance, retirement plans, paid holidays, and more. We comply with all regulatory wage laws.