Clinical Reviewer (Remote)

Maximus; Hampton (VA); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Clinical Reviewer to support a vital healthcare program. This fully remote position offers the opportunity to conduct clinical reviews, ensuring compliance with state and federal guidelines. You'll be part of a collaborative team, making impactful decisions regarding patient assessments. Enjoy a supportive work environment that values work-life balance, competitive compensation, and comprehensive benefits. If you're passionate about making a difference in healthcare, this role is perfect for you.

Benefits

Comprehensive Insurance Coverage

401K Retirement Savings Plan

Paid Time Off Package

Tuition Reimbursement

Employee Assistance Program

Professional Development Opportunities

Recognition Platform

Holistic Wellness Support

Qualifications

• Minimum 1 year of clinical experience required.
• Strong proficiency in written communication is preferred.

Responsibilities

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

Skills

Clinical Review

Communication Skills

Organizational Skills

Microsoft Office Suite

Data Collection and Analysis

Education

High School Degree

LPN, RN, LCSW or related licensure

Master's Degree in Social Work or related field

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 individuals' need for a more comprehensive PASRR assessment, and ensuring compliance with state and federal guidelines.

This is a fully remote position!

About the program: Maximus is contracted with Colorado Department of Health Care Policy and Financing to manage the statewide CO PASRR program. Starting July, 2025, we will begin managing submission of all Level I PASRR referrals and Status Changes, completion of clinical review to determine if a person has a known or suspected PASRR condition (SMI, ID or related condition), completion of the comprehensive person-centered Level II assessments. This role will be part of a collaborative team of professionals, working remotely, and will be responsible for completing the clinical review portion of the process and determining if a referred individual has one of the PASRR conditions.

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 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.
- Performs other related duties as assigned.

Required Skills/Abilities:

- Preferred knowledge may include community support programs, long-term care assessment and level of care in medical, behavioral health or related programs
- Knowledge and understanding of medical and/or behavioral health diagnoses and prescribed medications
- Ability to collect data, define problems, establish facts, and draw valid conclusions
- Excellent written and verbal communication skills
- Excellent interpersonal and customer service skills
- Proficient in Microsoft Office Suite
- Excellent organizational skills and attention to detail
- Ability to work in a fast-paced environment
- Ability to work independently and meet timelines

Minimum Requirements

- Education and licensure requirements are based on program contract requirements and are outlined in job posting
- High School Degree or equivalent required
- Minimum 1 year of clinical experience required
- LPN, RN, LCSW, or related licensure preferred and may be required based on contract requirements
-Master's degree in Social Work, Mental Health, or in a related field or RN with psychiatric experience
- Minimum1-2 years of experience working with individuals with serious mental illness (SMI), in the adult/older adult services field, or with chronic medical conditions.
- Minimum 1 year experience conducting mental health assessments or clinical review

Preferred Requirements

- Demonstrates strong proficiency in written communication, producing concise and impactful documentation

-Experience working with individuals diagnosed with IDD

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

#ClinicalServices #COAssessorAPR #maxPriority

EEO Statement

Active military service members, their spouses, and veteran candidates often embody the core competencies Maximus deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. Maximus is an Affirmative Action/Equal Opportunity Employer. Maximus provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

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.

Minimum Salary

$26.00

Maximum Salary

$30.67

Compensation:
$26-$31

Remote: Yes