Clinical Reviewer (Remote)

Maximus; Las Vegas (NV); Remote; Full time

Job summary

A leading healthcare company is seeking a Clinical Reviewer for a remote role supporting the Colorado PASRR Program. You'll conduct clinical reviews, evaluate assessments, and ensure compliance with guidelines while working in a collaborative team environment. The position offers flexibility, competitive compensation, and comprehensive insurance coverage, along with professional development opportunities.

Benefits

Competitive Compensation

Comprehensive Insurance Coverage

401K Retirement Savings plan

Paid Time Off Package

Tuition Reimbursement

Employee Perks and Discounts

Qualifications

• Minimum 1 year of clinical experience required.
• LPN, RN, LCSW, or related licensure preferred.

Responsibilities

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

Skills

Communication

Organizational Skills

Interpersonal Skills

Attention to Detail

Education

High School Degree

Master's degree 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 begin managing the submission of all Level I PASRR referrals and Status Changes, completing clinical reviews to determine if a person has a known or suspected PASRR condition (SMI, ID, or related condition), and conducting 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

• 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 related field or RN with psychiatric experience.
• Minimum 1-2 years of experience working with individuals with serious mental illness (SMI), in adult/older adult services, or with chronic medical conditions.
• Minimum 1 year experience conducting mental health assessments or clinical review.

Preferred Requirements

• 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 Mbps download, 50 Mbps shared, 5 Mbps upload).
• Private and secure workspace.

EEO & Pay Transparency

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 protected characteristics. Compensation is based on various factors including education, experience, and market conditions. Salary ranges are from $26.00 to $30.67 per hour.