Remote LPN Clinical Reviewer: HCBS & Policy

MAXIMUS; Montgomery (AL); Hybrid; USD 41,000 - 49,000; Full time

Benefits offered by this job

Company-issued equipment

Remote-friendly work policy

Job summary

MAXIMUS seeks a qualified clinical reviewer in Montgomery, AL to assess service requests, ensure policy and contract compliance, and issue determinations with documented rationale.

The role requires an active nursing license (LPN/associations) and 2+ years of experience with complex disabilities; familiarity with HCBS and Microsoft Office is essential. Remote-ready expectations and secure documentation practices are emphasized.

Qualifications

• Must hold an active clinical license and meet contract-specific experience requirements.
• Associate degree in Nursing is required.
• An active LPN license in Colorado or a compact license is required.
• Minimum 2 years of experience with people with complex disabilities, including pediatric and geriatric populations.
• Familiarity with HCBS waivers.
• Proficiency in Microsoft Office applications.

Responsibilities

• Review requests for services, including admissions, discharges, and continued stays for adherence to clinical criteria, state and federal policy, and contract requirements.
• Issue approvals, denials, or recommendations based on contract requirements; ensure quality, consistency, and adherence to clinical and regulatory standards across cases.
• Identify the need for additional clinical documentation or consultation and analyze information gaps to support accurate and timely determinations.
• Complete accurate documentation of review activities within contract systems.
• Communicate and collaborate with providers, individuals and their designees, state workers, and external stakeholders to clarify requirements, resolve issues, and support program outcomes.
• Provide guidance, coaching, training and quality review for team members; identify opportunities to improve review processes and consistency.
• May meet with external clients to confirm and update clinical guidelines that must be followed internally.
• May write high-quality, fully substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation, including completing the summary of findings.

Skills

Microsoft Office

Clinical policy adherence

Communication skills

Education

Associate degree in Nursing

LPN license (CO or compact)

Job description

MAXIMUS seeks a qualified clinical reviewer in Montgomery, AL to assess service requests, ensure policy and contract compliance, and issue determinations with documented rationale.

The role requires an active nursing license (LPN/associations) and 2+ years of experience with complex disabilities; familiarity with HCBS and Microsoft Office is essential. Remote-ready expectations and secure documentation practices are emphasized.