Clinical Reviewer, RN / LPN (Remote)

Maximus; Dallas (TX); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare company is seeking a detail-oriented Clinical Reviewer, RN/LPN to support the Connecticut PASRR Program remotely. Responsibilities include reviewing service requests for clinical criteria adherence and making decisions on long-term care placements. The ideal candidate will have clinical experience, an active nursing license, and a solid understanding of medical and behavioral health assessments.

Benefits

Work / Life Balance Support

Comprehensive Insurance Coverage

401K Retirement Savings plan with Company Matching

Paid Time Off and Holidays

Tuition Reimbursement

Professional Development Opportunities

Qualifications

• At least 1 year of clinical experience required.
• Minimum 3 years in behavioral or mental health field.
• Active and unrestricted RN or LPN license necessary.

Responsibilities

• Review service requests for adherence to criteria.
• Issue approvals, denials, or recommendations as necessary.
• Communicate with providers as required.

Skills

Knowledge of community support programs

Understanding of medical and behavioral health diagnoses

Ability to collect data and draw valid conclusions

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 other programs. In this role, you will support multiple programs by reviewing Level I PASRR screens and making clinical decisions regarding long-term care placement. This position 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 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 - Various plans including 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 - PTO, Holidays, extended sick leave, and Short and Long Term Disability coverage.
• Holistic Wellness Support - Resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
• Recognition Platform - Acknowledge outstanding employee contributions.
• Tuition Reimbursement - Support for ongoing education and development.
• Employee Perks and Discounts - Additional benefits and discounts for employees.
• Wellness Programs - Access to wellness resources tailored to your needs.
• Professional Development - Training programs, workshops, and conferences.
• Licensures and Certifications - Maximus covers expenses for renewing licenses and certifications.

Essential Duties and Responsibilities

• Review service requests, 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 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 assessments, and level of care in medical or behavioral health programs.
• 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.
• At least 1 year of clinical experience.
• Minimum 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-provided computer equipment.
• Reliable high-speed internet (minimum 20 Mbps download, 5 Mbps upload).
• Private and 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, or other protected characteristics.

Pay Transparency

Salary ranges from $22.00 to $30.00 per hour, based on various factors including experience, education, and location. Maximus offers a comprehensive benefits package, including health insurance, retirement plans, paid time off, and more. Salary history is not used in compensation decisions, and the company complies with all wage and salary regulations.