Clinical Reviewer, RN / LPN (Remote)

Maximus; Miami (FL); Remote; Full time

Job summary

Maximus seeks a Clinical Reviewer, RN / LPN for remote support of the Connecticut PASRR Program. This role involves reviewing Level I PASRR screens and making clinical decisions regarding long-term care placements, ensuring individuals receive the appropriate care and services necessary, while providing a flexible and supportive work environment.

Benefits

Competitive Compensation with bonuses

Comprehensive Insurance Coverage

401K Retirement Savings Plan with Company Matching

Paid Time Off Package

Tuition Reimbursement

Qualifications

• Minimum 1 year of clinical experience required.
• Minimum 3 years of experience in behavioral or mental health.
• Licensure as RN or LPN is mandatory.

Responsibilities

• Review requests for services for adherence to clinical criteria.
• Issue approvals, denials, or recommendations based on contract requirements.
• Communicate with providers and state workers as required.

Skills

Knowledge of medical diagnoses

Ability to collect data

Understanding of long-term care

Education

High School Degree or equivalent

Active RN or LPN license

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 who are applying to, or residing in, Medicaid-certified nursing homes.

The primary goal 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 works as a critical function to help match 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 and certifications for its employees. Essential Duties and Responsibilities : - Review requests for services including admission, 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 need for additional clinical documentation or consultation. - Complete documentation of activities within contract systems. - Communicate with providers, individuals and their designees, or state workers as required. - Performs other related duties as assigned. Required Skills / Abilities : - Preferred knowledge may include community support programs, long-term care assessment and level of care in medical, behavioral health or related programs - Knowledge and understanding of medical and / or behavioral health diagnoses and prescribed medications - Ability to collect data, define problems, establish facts, and draw valid conclusions Minimum Requirements - Education and licensure requirements are based on program contract requirements and are outlined in job posting - High School Degree or equivalent required - Minimum 1 year of clinical experience required - Minimum of 3 years of experience in the behavioral or mental health field - Hold an active and unrestricted license as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) Preferred Requirements - Prior experience with Pre-Admission Screening and Resident Review (PASRR) assessments - Prior experience reviewing mental health or medical assessments Home Office Requirements - Maximus provides company-issued computer equipment - Reliable high-speed internet service - Minimum 20 Mpbs download speeds / 50 Mpbs for shared internet connectivity - Minimum 5 Mpbs upload speeds - 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 and other legally protected characteristics. Pay Transparency Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.

Annual salary is just one component of Maximus's total compensation package.

Other rewards may include short- and long-term incentives as well as program-specific awards.

Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off.

Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience.

An applicant's salary history will not be used in determining compensation.

Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances. Minimum Salary $ 22.00 Maximum Salary $ 30.00