Clinical Reviewer (Remote)

MAXIMUS; Philadelphia (Philadelphia County); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking a Clinical Reviewer for the Mississippi PASRR Program. This fully remote role involves conducting clinical reviews, ensuring compliance with guidelines, and supporting individuals in Medicaid-certified nursing homes. The position offers competitive compensation and comprehensive benefits, including flexible work-life balance and professional development opportunities.

Benefits

Competitive Compensation

Comprehensive Insurance Coverage

401K Retirement Savings Plan

Paid Time Off Package

Tuition Reimbursement

Qualifications

• Minimum 1 year of clinical experience required.
• High School Degree or equivalent required.

Responsibilities

• Conduct clinical reviews for PASRR assessments.
• Issue approvals, denials, or recommendations based on contract requirements.
• Complete documentation of activities within contract systems.

Skills

Communication

Interpersonal Skills

Organizational Skills

Attention to Detail

Data Collection

Education

High School Degree

Master's Degree in Social Work

Tools

Microsoft Office Suite

Job description

Maximus is seeking a dedicated and detail-oriented Clinical Reviewer to support the Mississippi 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 role that does not require a license and follows Central Time Zone hours.

About the Program

We partner with the Division of Medicaid to perform Level II on-site evaluations for the Preadmission Screening and Resident Review (PASRR) program - and have done so since 2012. PASRR assessments are performed on individuals who are applying to, or residing in, Medicaid-certified nursing homes. The primary objective of this federally-mandated assessment is to determine whether the nursing home is the appropriate placement for individuals with mental illness, intellectual disabilities or developmental disabilities. PASRR also works as a critical function to help match individuals with the care and services they need.

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

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
• 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 related degree program
• Prior experience reviewing medical assessments
• Minimum of 2 years clinical experience in mental health
• Ability to manage tight turnaround times effectively.
• Proficiency in navigating and efficiently utilizing multiple healthcare systems.

Preferred Requirement

• Prior experience with (PASRR) Pre-Admission Screening and Resident Review assessments.

Home Office Requirements

• 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

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.

Minimum Salary

20.00

Maximum Salary

26.00

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Clinical Reviewer • Philadelphia, PA, United States