Clinical Reviewer (Remote)

Description & Requirements

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 a clinical review of Level I PASRR screens, evaluating the completed screen, making determinations regarding an 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 who are 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 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

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...