Clinical Reviewer - (Remote)

Maximus; Northern (KY); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Comprehensive Insurance Coverage

Paid Time Off Package

401K Retirement Savings plan

Tuition Reimbursement

Wellness Program

Job summary

Maximus is hiring a Clinical Reviewer to support the Illinois SALT program. The Clinical Reviewer evaluates assessments and makes determinations regarding individuals' needs for additional supports and services.

The role includes conducting quality control reviews of field assessors' work to ensure accuracy and compliance. The position requires a Master’s degree in a related field or an active RN license, with several years of post-graduate mental health experience.

Qualifications

• High school diploma or GED required with 2+ years of related professional experience.
• Advanced degree or RN license required as stated.
• Proficiency in Microsoft Office Applications.

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; escape 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.

Skills

Interpersonal skills

Verbal communication

Written communication

Microsoft Office

IM+CANS certification

PASRR knowledge

Education

Master's degree in counseling, social work, psychology or related field

RN license (active and unrestricted)

Tools

Microsoft Office Suite

Job description

Maximus is hiring a Clinical Reviewer to support the Illinois SALT program. The Clinical Reviewer is responsible for evaluating assessments and making determinations regarding individuals' needs for additional supports and services. This role includes conducting quality control reviews of field assessors' work to ensure accuracy and compliance.

Training Schedule

• Monday to Friday, 8:00 AM - 5:00 PM CST

Post-Training Work Schedule

• Thursday to Sunday, 8:00 AM - 6:30 PM CST

About the program

We have contracted with the State of Illinois Department of Healthcare and Family Services (HFS) to manage the assessment process for Preadmission Screening and Resident Review (PASRR) Level I screens and completing Level II Serious Mental Illness (SMI) evaluations for individuals applying to, or residing in, Medicaid-certified nursing facilities. Other services include Follow Up Visits; admissions support for Specialized Mental Health Rehabilitation Facilities (SMHRF) and Supported Living Programs (SLP) settings and Colbert Dementia Review. Continues to expand assessment services in the state.

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.

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; escape 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.

High School and Experience

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

Advanced Education and Licensure

• Master's degree in counseling, social work, psychology, closely related field OR must have an active, unrestricted RN license - Minimum of two (2) years post-graduate work experience in the mental health field - Minimum of two (2) years' experience conducting mental health assessments - Proficiency in Microsoft office Applications

Preferred Requirements

• Demonstrates outstanding interpersonal and verbal communication skills
• Demonstrates strong proficiency in written communication, producing concise and impactful documentation
• IM+CANS certification or willingness to obtain IM+CANS certification
• Strong computer skills
• Knowledgeable about PASRR

Home Office Requirements

• Maximus provides company-issued computer equipment
• Reliable high-speed internet service
• Minimum 20 Mbps download speeds/50 Mbps for shared internet connectivity
• Minimum 5 Mbps upload speeds
• Private and secure workspace #ClinicalServices

EEO Statement

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.

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.

Accommodations

Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process—including accessing job postings, completing assessments, or participating in interviews,—please contact People Operations at [e-mail].