Clinical Reviewer (Remote)

Maximus; Hagåtña (GU); A distancia; USD 34.000 - 44.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Work/Life Balance support

Bonuses based on performance

Comprehensive insurance coverage

401K retirement plan with companyMatch

Paid time off and holidays

Wellness resources

Tuition reimbursement

Employee discounts

Wellness program

Descripción de la vacante

Maximus seeks a Clinical Reviewer (Remote) to support the Iowa PASRR program, coordinating and facilitating clinical assessments to ensure appropriate care levels. You will review documentation and serve as a key contact for assessors, ensuring compliance with state and federal requirements.

This role requires strong organization, attention to detail, and the ability to work independently while collaborating with a multidisciplinary team to promote timely assessments.

Formación

• High school diploma or GED with 2 years of relevant professional experience, or equivalent.
• Master’s degree in Human Sciences or related OR active RN license.
• Minimum of two years direct care experience with individuals with serious mental illness and/or IDD.

Responsabilidades

• Review service requests using established clinical criteria, state and federal policy, and contract requirements; avoid complex or non-standard cases.
• Issue approvals, denials, or recommendations based on contract requirements and standardized decision frameworks.
• Identify need for additional clinical documentation or consultation and seek guidance from senior staff as appropriate.
• Complete timely and accurate documentation of review activities within contract systems.
• Communicate with providers, individuals and their designees, or state workers as required.
• May write high-quality, fully substantiated clinical determination reports by synthesizing assessment findings and supporting documentation.

Conocimientos

Excellent written communication skills

Educación

Master’s degree in Human Sciences or related

Active RN license

Descripción del empleo

Maximus is seeking a Clinical Reviewer (Remote) to support the Iowa PASRR program in a remote capacity. In this role, you will coordinate and facilitate clinical assessments to ensure individuals receive the appropriate level of care and services. The Clinical Assessment Coordinator serves as a key point of contact, supporting assessors, reviewing documentation, and ensuring compliance with state and federal requirements. This position requires strong organizational skills, attention to detail, and the ability to work independently while collaborating with a multidisciplinary team to promote accurate and timely assessments.

About the program: The Iowa Preadmission Screening and Resident Review (IA PASRR) program is a federally mandated process that ensures individuals with mental illness, intellectual disabilities, or related conditions are appropriately placed in Medicaid-certified nursing facilities and connected to the right level of care. It involves a two-step process: a Level I screening to identify potential conditions and a Level II evaluation for those who require a more detailed clinical review. The goal of Iowa PASRR is to protect vulnerable populations by confirming nursing facility placement is appropriate, identifying specialized services, and promoting opportunities for individuals to live in the least restrictive and most supportive environment possible.

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 service requests that are typically routine, including admissions, discharges, and continued stays, using established clinical criteria, state and federal policy, and contract requirements; evade complex or non-standard cases that fall outside defined protocols.
• Issue approvals, denials, or recommendations based on contract requirements and standardized decision frameworks.
• Identify the need for additional clinical documentation or consultation and seek guidance from senior staff as appropriate.
• Complete timely and accurate documentation of review activities within contract systems in accordance with established procedures.
• Communicate with providers, individuals and their designees, or state workers as required.
• 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

'- High school diploma or GED required and 2 years of relevant professional experience required, or equivalent combination of education and experience.

'- Master’s degree in Human Sciences or related OR active Registered Nurse (RN) license.

• Minimum of two (2) years of direct care experience working with individuals with serious mental illness and/or intellectual and developmental disabilities (IDD).

Preferred Requirements:

• Current or previous PASRR experience
• Excellent written and communication skills
• Ability to shift priorities and pivot between tasks

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

$25

Maximum Salary

$32