Job description
Maximus is seeking a Clinical Reviewer (LPN) supporting the Colorado HMA (Health Maintenance Activities) Review Program. This role requires completion of desk based clinical reviews to determine appropriateness of recommended services, supports program goals and service level agreements (SLAs). The reviewer must participate in all required trainings and meetings, in addition to other tasks as required by their supervisor.
Position is contingent upon contract award**
Work Schedule: This position is scheduled Monday through Friday from 8:00 a.m. to 5:00 p.m. Mountain Time with some weekend coverage required based on business needs.
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.
Requirements
- Minimum Requirements: Current Licensed Practical Nurse (LPN) license valid in the state of practice is required
High School Degree or equivalent required
Minimum 2 years of clinical experience required
Associate degree in Nursing
An active LPN license in the state of Colorado or a compact license is required
Minimum 2 years of experience working with people with complex disabilities, including pediatric and geriatric populations
Familiarity with Home and Community Based Services waivers (HCBS)
Proficiency in Microsoft Office applications
Preferred Requirements: Prior experience conducting document-based reviews
Excellent written and communication skills
Previous experience working remotely
Prior experience conducting document-based reviews
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
About Maximus
We’re moving people forward by providing transformative technology services, digitally enabled customer experiences, and clinical health services that change lives.
Our employees share an authentic desire to make vital services available to the public and support the missions of our customers.
