Clinical Reviewer (Remote)

Maximus; Spokane (WA); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking a dedicated Clinical Reviewer for a fully remote role to conduct clinical reviews and ensure compliance with state and federal guidelines. The position requires strong communication and organizational skills, with a focus on supporting individuals with mental health conditions. Competitive compensation and comprehensive benefits are offered, including flexible work-life balance and professional development opportunities.

Benefits

Competitive Compensation

Comprehensive Insurance Coverage

401K Retirement Savings plan with Company Matching

Paid Time Off Package

Tuition Reimbursement

Wellness Programs

Professional Development

Qualifications

• Minimum 1 year of clinical experience.
• Preferred licensure: LPN, RN, LCSW, or related.

Responsibilities

• Review service requests for adherence to clinical criteria.
• Issue approvals, denials, or recommendations based on contract requirements.
• Document activities within contract systems.

Skills

Communication

Organizational skills

Problem definition

Customer service

Education

High School Degree or equivalent

Master's in Social Work

Tools

Microsoft Office

Job description

Maximus is seeking a dedicated and detail-oriented Clinical Reviewer to support the Colorado PASRR Program. In this remote role, you will conduct clinical reviews of Level I PASRR screens, evaluate completed screens, determine the need for comprehensive PASRR assessments, and ensure compliance with state and federal guidelines.

This is a fully remote position!

About the program:

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 manage the submission of all Level I PASRR referrals and status changes, conduct clinical reviews to identify PASRR conditions (SMI, ID, or related), and complete comprehensive person-centered Level II assessments. This role involves working remotely as part of a collaborative team, focusing on the clinical review process to identify PASRR conditions.

Why Maximus?

• Work/Life Balance Support - Flexibility tailored to your needs!
• Competitive Compensation - Bonuses based on performance included!
• Comprehensive Insurance Coverage - Medical, Dental, Vision, Prescription, and partially funded HSA plans; Life insurance; Discounts on Auto, Home, Renter's, and Pet insurance.
• Future Planning - 401K Retirement Savings plan with Company Matching.
• Paid Time Off Package - PTO, Holidays, extended sick leave, Short and Long Term Disability coverage.
• Holistic Wellness Support - Resources for physical, emotional, and financial wellness via our Employee Assistance Program (EAP).
• Recognition Platform - Acknowledge outstanding contributions.
• Tuition Reimbursement - Support for ongoing education and development.
• Employee Perks and Discounts - Exclusive benefits for employees.
• Wellness Programs - Access to various wellness resources.
• Professional Development - Training, workshops, and conferences.
• Licensures and Certifications - Maximus covers renewal expenses.

Essential Duties and Responsibilities:

• Review service requests (admissions, discharges, continued stays) for adherence to clinical criteria and policies.
• Issue approvals, denials, or recommendations based on contract requirements.
• Identify need for additional documentation or consultation.
• Document activities within contract systems.
• Communicate with providers, individuals, designees, and state workers as required.
• Perform other related duties as assigned.

Required Skills/Abilities:

• Knowledge of community support programs, long-term care assessment, and level of care in medical/behavioral health.
• Understanding of medical/behavioral health diagnoses and medications.
• Data collection, problem definition, and analysis skills.
• Excellent written and verbal communication.
• Interpersonal and customer service skills.
• Proficiency in Microsoft Office.
• Organizational skills and attention to detail.
• Ability to work in a fast-paced environment independently and meet deadlines.

Qualifications:

• High School Degree or equivalent.
• Minimum 1 year of clinical experience.
• Preferred licensure: LPN, RN, LCSW, or related.
• Master's in Social Work, Mental Health, or related field or RN with psychiatric experience.
• At least 1-2 years working with individuals with SMI or chronic medical conditions.
• Minimum 1 year conducting mental health assessments or clinical reviews.

Preferred Requirements:

• Strong proficiency in concise, impactful written communication.
• Experience working with individuals with IDD.

Home Office Requirements:

• Company-issued computer equipment.
• Reliable high-speed internet (minimum 20 Mbps download, 5 Mbps upload).
• Private, secure workspace.

#ClinicalServices #COAssessorAPR #maxPriority

EEO Statement

Maximus values diversity and encourages military service members, veterans, and their spouses to apply. We are an Affirmative Action/Equal Opportunity Employer, providing equal employment opportunities regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability.

Pay Transparency

Compensation is based on various factors including location, education, experience, and market conditions. Salary ranges from $26.00 to $30.67 per hour, with total rewards including benefits, incentives, and bonuses. Maximus complies with all applicable wage laws and does not consider salary history in compensation decisions.