Clinical Reviewer, RN/LPN (Remote in TN)

Description & Requirements

Maximus is seeking a dedicated Clinical Review RN or LPN to join our team! In this role, you'll perform document-based and telephonic reviews to evaluate medical necessity and screen for serious mental illness or intellectual disabilities.

Your assessments will help determine the appropriate level of care, including eligibility for short- or long-term nursing facility placement.

This is a remote role that follows Central Time Zone business hours.

About the Program

We partner with the State of Tennessee 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

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:
- Preferr...