Clinical Reviewer (Remote)

Maximus; Portland (OR); Remote; USD 80,000 - 100,000; Full time

Job summary

Maximus is seeking a Clinical Reviewer for the Mississippi PASRR Program. This remote role involves conducting clinical reviews, ensuring compliance with guidelines, and collaborating with healthcare providers. The position offers competitive compensation and a comprehensive benefits package, supporting work-life balance and professional development.

Benefits

Work / Life Balance Support

Competitive Compensation

Comprehensive Insurance Coverage

401K Retirement Savings plan

Paid Time Off Package

Holistic Wellness Support

Tuition Reimbursement

Professional Development Opportunities

Licensures and Certifications

Qualifications

• Minimum 1 year of clinical experience required.
• LPN, RN, LCSW, or related licensure preferred.
• Minimum of 2 years clinical experience in mental health.

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

Interpersonal Skills

Customer Service

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

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 helps 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 the need for additional clinical documentation or consultation.
• Complete documentation of activities within contract systems.
• Communicate with providers, individuals, 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

• 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 assessments.

Home Office Requirements

• Reliable high-speed internet service with minimum 20 Mbps download and 5 Mbps upload speeds.
• Private and secure workspace.

EEO & Pay Transparency

Maximus is an equal opportunity employer. Compensation ranges from $20.00 to $26.00 per hour, based on various factors including experience and location. Maximus provides a comprehensive benefits package, including health insurance, retirement plans, paid time off, and more.