Clinical Reviewer (Remote)

Maximus; Tucson (AZ); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading company is seeking a dedicated Clinical Reviewer to conduct clinical assessments for the Colorado PASRR Program. This remote role involves evaluating Level I PASRR screens and ensuring compliance with guidelines. Ideal candidates will possess strong communication skills and clinical experience, with opportunities for professional development and competitive compensation.

Benefits

Comprehensive Insurance Coverage

401K Retirement Savings plan with Company Matching

Paid Time Off Package

Tuition Reimbursement

Wellness Programs

Professional Development

Qualifications

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

Responsibilities

• Review requests for services including admissions and discharges.
• Issue approvals, denials, or recommendations based on contract requirements.
• Complete documentation within contract systems.

Skills

Communication

Interpersonal Skills

Organizational Skills

Attention to Detail

Education

High School Degree

Master's in Social Work

Tools

Microsoft Office Suite

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

Program Overview

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 submission of all Level I PASRR referrals and status changes, complete clinical reviews to determine if a person has a known or suspected PASRR condition (SMI, ID, or related condition), and perform comprehensive person-centered Level II assessments. This role involves working remotely as part of a collaborative team of professionals, responsible for the clinical review 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: Medical, Dental, Vision, Prescription, partially funded HSA, Life insurance, and 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 Employee Assistance Program (EAP).
• Recognition Platform: Acknowledge and appreciate employee contributions.
• Tuition Reimbursement: Support for ongoing education and development.
• Employee Perks and Discounts: Exclusive benefits for employees.
• Wellness Programs: Access to tailored wellness resources.
• Professional Development: Training programs, workshops, and conferences.
• Licensures and Certifications: Maximus covers renewal expenses for licenses and certifications.

Essential Duties and Responsibilities

• Review requests for services including admissions, discharges, and continued stays for adherence to clinical criteria, policies, and requirements.
• Issue approvals, denials, or recommendations based on contract requirements.
• Identify need for additional clinical documentation or consultation.
• Complete documentation within contract systems.
• Communicate with providers, individuals, designees, or 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 or behavioral health.
• Understanding of medical/behavioral health diagnoses and medications.
• Ability to collect data, define problems, establish facts, and draw valid conclusions.
• Excellent written and verbal communication skills.
• Strong interpersonal and customer service skills.
• Proficiency in Microsoft Office Suite.
• Excellent organizational skills and attention to detail.
• Ability to work in a fast-paced environment independently and meet deadlines.

Minimum Requirements

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

Preferred Requirements

• Proficiency in concise, impactful documentation.
• Experience with individuals diagnosed with IDD.

Home Office Requirements

• Company-issued equipment and reliable internet (minimum 20 Mbps download, 50 Mbps shared, 5 Mbps upload).
• Private, secure workspace.

#ClinicalServices #COAssessorAPR #maxPriority

EEO & Pay Transparency

Maximus is an equal opportunity employer. Compensation ranges from $26.00 to $30.67 per hour, based on various factors including experience, education, and market conditions. Benefits include health insurance, retirement plans, paid holidays, and more.