Clinical Reviewer LPN - (Remote)

Essential Duties and Responsibilities:
- Review requests for services, including admissions, discharges, and continued stays for adherence to clinical criteria, state and federal policy, and contract requirements involving broad clinical complexity and variability; escalate complex and non-standard cases that are exceptions to policies.
- Issue approvals, denials, or recommendations based on contract requirements, applying judgment and analysis to interpret guidelines in non-routine 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 with providers, individuals and their designees, or state workers as required.
- Serve as an internal resource to team members within established processes.
- May write high-quality, fully substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation, including completing the summary of findings.

Minimum Requirements

- Specific clinical license and experience requirements based on contract requirements.

- High School Degree or equivalent required

- Current and Active Licensed Practical Nurse (LPN) license in State of Illinois or Compact license

- Minimum 2 years of experience in Medical Nursing and/or Mental Health

- Proficiency in MS Office Applications such as Outlook, Excel, Power Point, and Word

Preferred Requirements

- 4+ years of experience in Medical Nursing and/or Mental Health

- Prior Intellectual and Developmental Disabilities experience

- Prior experience with Level I PASRR screenings

- Effective communication skills and ability to follow directions

- Ability to interact courteously and effectively with a variety of people

- Ability to handle pressure and perform multiple tasks

- Must be able to (at minimum) type 35 WPM

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

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.

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