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The Clinical Reviewer will conduct Level I PASRR screenings and evaluate clinical documentation to ensure appropriate care for individuals in long-term settings. They will also coordinate with healthcare providers and maintain compliance with state and federal program standards.
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 and certifications for its employees.
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.
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