Clinical Reviewer, RN or LPN (Remote - TN)

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.

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 2 years of clinical experience required

- An active unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license valid in Tennessee state or a compact nursing license with Tennessee privileges.
- Minimum of two (2) years of clinical experience in a Registered Nurse (RN) or Licensed Practical Nurse (LPN) position.

- Proficiency in Microsoft Office Suite (Word, Outlook, Excel), Adobe

- Strong clinical assessment, critical thinking, documentation skills, and the ability to apply clinical judgment accurately in a fast-paced environment.

- Strong written and verbal communication skills.

Preferred Requirements

- Experience navigating and documenting clinical reviews within utilization management or authorization database platforms (e.g., Legacy AMI or similar systems)
- Proficiency with electronic medical records and clinical documentation systems
- Prior utilization review, care management, or clinical review experience
- Candidates who reside in Tennessee state

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

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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 ...