Clinical Reviewer, RN/LPN (Remote - TN)

About The Program

Maximus partners with the State of Tennessee to conduct Preadmission Screening and Resident Review (PASRR)—a federally mandated process designed to determine whether a nursing facility is the appropriate level of care; identify individuals with mental illness, intellectual disabilities, or developmental disabilities and help connect individuals with the services and supports they need.

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

• High School Degree or equivalent required.
• Minimum 2 years of clinical experience required.
• Current and valid Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in the state of Tennessee.
• 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 in care management and documenting clinical reviews.
• Proficiency with electronic medical records and clinical documentation systems.

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.

Benefits

• 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 and certifications for its employees.

Pay

Minimum Salary $26.00, Maximum Salary $28.00