Clinical Reviewer (Remote)

Maximus; United States; Remote; USD 45,000 - 75,000; Full time

Job summary

An established industry player is seeking a detail-oriented Clinical Reviewer for a remote role supporting the Mississippi PASRR Program. This position involves conducting clinical reviews, evaluating assessments, and ensuring compliance with guidelines. The ideal candidate will have a strong background in clinical assessment and excellent communication skills. Enjoy the benefits of a flexible work environment, competitive compensation, and comprehensive insurance coverage. Join a team that values work-life balance and professional development opportunities, making a significant impact on the lives of individuals in need of care.

Benefits

Work/Life Balance Support

Comprehensive Insurance Coverage

401K Retirement Savings Plan

Paid Time Off Package

Tuition Reimbursement

Professional Development Opportunities

Recognition Platform

Qualifications

• Minimum 1 year of clinical experience required.
• Understanding of medical and behavioral health diagnoses.

Responsibilities

• Conduct clinical reviews of Level I PASRR screens.
• Communicate with providers and individuals as required.

Skills

Clinical Assessment

Communication Skills

Interpersonal Skills

Microsoft Office Suite

Organizational Skills

Education

High School Degree

Master’s Degree in Social Work

Job description

Join to apply for the Clinical Reviewer (Remote) role at Maximus

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 clinical reviews of Level I PASRR screens, evaluating completed screens, making determinations regarding 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 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 plays a critical role in matching 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 admissions, 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

• Knowledge may include community support programs, long-term care assessment, and level of care in medical, behavioral health, or related programs.
• Understanding of medical and behavioral health diagnoses and prescribed 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.
• Proficient in Microsoft Office Suite.
• Excellent organizational skills and attention to detail.
• Ability to work in a fast-paced environment and independently meet deadlines.

Minimum Requirements

• High School Degree or equivalent required.
• Minimum 1 year of clinical experience required.
• Preferred licensure: LPN, RN, LCSW, or related; may be required based on contract.
• Master’s Degree in Social Work, Mental Health, or related field.
• Prior experience reviewing medical assessments.
• Minimum of 2 years clinical experience in mental health.
• Ability to manage tight turnaround times effectively.
• Proficiency in navigating multiple healthcare systems.

Preferred Requirement

• Prior experience with PASRR assessments.

Home Office Requirements

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

Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, or genetic information.