Clinical Reviewer, RN / LPN (Remote)

Maximus; Bridgeport (CT); Remote; USD 80,000 - 100,000; Full time

Job summary

Maximus is seeking a Clinical Reviewer (RN/LPN) to review clinical assessments for long-term care placements. This fully remote position requires a valid RN or LPN license and experience in behavioral health, offering a competitive salary with comprehensive benefits.

Benefits

Comprehensive Insurance Coverage

401K Retirement Savings with Company Matching

Tuition Reimbursement

Employee Perks and Discounts

Holistic Wellness Support

Qualifications

• Minimum 1 year of clinical experience required.
• Active RN or LPN license is mandatory.
• 3 years in the behavioral or mental health field preferred.

Responsibilities

• Review requests for admission and continued stays based on clinical criteria.
• Issue approvals and communicate with various stakeholders.
• Complete detailed documentation as required.

Skills

Community support programs

Long-term care assessment

Data collection

Problem definition

Education

High School Degree or equivalent

Job description

Description & Requirements Maximus is seeking a detail-oriented Clinical Reviewer, RN / LPN to support the Connecticut PASRR Program and multiple other programs. In this position, you will act in a floating capacity between programs and be responsible for reviewing Level I PASRR screens and making clinical decisions regarding the appropriateness of long-term care (LTC) placement. This role is 100% remote with no travel or on-site requirements.

About the Program :

We partner with the Department of Social Services to perform Preadmission Screening and Resident Review (PASRR) for individuals applying to or residing in Medicaid-certified nursing homes. The primary goal is to determine if the nursing home is appropriate for individuals with mental illness, intellectual disabilities, or developmental disabilities. PASRR helps match individuals with the necessary care and services.

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. Life insurance benefits 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 through EAP.
• Recognition Platform - Acknowledge outstanding contributions.
• Tuition Reimbursement - Support for ongoing education and development.
• Employee Perks and Discounts - Additional benefits for employees.
• Maximus Wellness Program and Resources
• Professional Development Opportunities - Training, workshops, and conferences.
• Licensures and Certifications - Maximus covers renewal expenses.

Essential Duties and Responsibilities :

• Review requests for admission, 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 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 and behavioral health diagnoses and medications.
• Ability to collect data, define problems, establish facts, and draw valid conclusions.

Minimum Requirements :

• High School Degree or equivalent.
• Minimum 1 year of clinical experience.
• Minimum of 3 years in behavioral or mental health field.
• Active and unrestricted RN or LPN license.

Preferred Requirements :

• Experience with PASRR assessments.
• Experience reviewing mental health or medical assessments.

Home Office Requirements :

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

#LI-Remote

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 protected characteristics.

Pay Transparency :

Salary ranges from $22.00 to $30.00 per hour, based on various factors including experience, education, and market conditions. Maximus offers a comprehensive benefits package including health insurance, retirement plans, paid time off, and more.