Clinical Reviewer, RN or LPN (Remote - TN)

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.

Maximus is hiring a Clinical Reviewer, RN or LPN to support our PASRR program for the State of Tennessee. In this role, you will review clinical documentation and requests submitted by individuals and/or providers to determine appropriate level of care and prior authorization needs. You will also review Level I PASRR screenings, evaluate completed assessments, and determine when a Level II comprehensive PASRR evaluation is required. This position plays a key role in ensuring accurate, timely, and compliant clinical determinations for individuals applying to or residing in Medicaid‑certified nursing homes.

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.