Clinical Reviewer - (Remote)
Essential Duties and Responsibilities:
- Review service requests that are typically routine, including admissions, discharges, and continued stays, using established clinical criteria, state and federal policy, and contract requirements; escalate complex or non-standard cases that fall outside defined protocols.
- Issue approvals, denials, or recommendations based on contract requirements and standardized decision frameworks.
- Identify the need for additional clinical documentation or consultation and seek guidance from senior staff as appropriate.
- Complete timely and accurate documentation of review activities within contract systems in accordance with established procedures.
- Communicate with providers, individuals and their designees, or state workers as required.
- 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
- High school diploma or GED required and 2+ years of relevant professional experience required, or equivalent combination of education and experience.
- Master's degree in counseling, social work, psychology, closely related field OR must have an active, unrestricted RN license
- Minimum of two (2) years post-graduate work experience in the mental health field
- Minimum of two (2) years' experience conducting mental health assessments
- Proficiency in Microsoft office Applications
Preferred Requirements:
- Demonstrates outstanding interpersonal and verbal communication skills
- Demonstrates strong proficiency in written communication, producing concise and impactful documentation
- IM+CANS certification or willingness to obtain IM+CANS certification
- Strong computer skills
- Knowledgeable about PASRR
Home Office Requirements:
- Maximus provides company-issued computer equipment
- Reliable high-speed internet service
- Minimum 20 Mbps download speeds/50 Mbps for shared internet connectivity
- Minimum 5 Mbps upload speeds
- Private and secure workspace
#ClinicalServices
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 may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.
Accommodations
Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.
Minimum Salary
$
25.07
Maximum Salary
$
30.67
Remote
Skills:
Broadband, Clinical Study Publications, Communication Skills, Computer Skills, Contract Requirements, Documentation, Employee Orientation, Federal Contracts, Internet/Online Service, Interpersonal Skills, Maintenance Services, Microsoft Office, Presentation/Verbal Skills, Psychiatry and Mental Health, Psychology, Registered Nurse (RN), Social Work, Writing Skills
Maximus
MAXIMUS provides business services to help governments operate health and human services programs, mostly at the state and national levels. The company's health services segment offers outsourced program management and administrative services,
Company Size:
5,000 to 9,999 employees
Industry:
Healthcare Services
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Website:
