Clinical Reviewer (Remote)

Maximus; Los Angeles (CA); Remote; Full time

Job summary

An established industry player is seeking a Clinical Reviewer for a remote position supporting a vital health program. This role involves conducting clinical reviews to assess individuals' needs for comprehensive evaluations while ensuring compliance with state and federal guidelines. The successful candidate will join a collaborative team, leveraging their clinical expertise to make impactful decisions. With a focus on work-life balance and competitive compensation, this opportunity is perfect for those passionate about making a difference in healthcare while enjoying the flexibility of remote work.

Benefits

Work / Life Balance Support

Competitive Compensation

Comprehensive Insurance Coverage

Life Insurance Benefits

401K Retirement Savings Plan

Paid Time Off Package

Holistic Wellness Support

Tuition Reimbursement

Professional Development Opportunities

Licensures and Certifications Coverage

Qualifications

• Minimum 1 year of clinical experience required.
• Knowledge of medical and behavioral health diagnoses preferred.

Responsibilities

• Conduct clinical reviews for PASRR assessments and compliance.
• Issue approvals or denials based on clinical criteria.

Skills

Clinical Review

Communication Skills

Interpersonal Skills

Data Collection and Analysis

Attention to Detail

Microsoft Office Suite

Education

High School Degree or equivalent

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.
• 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.
• Perform 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.
• Minimum 1-2 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.

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.

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