Clinical Reviewer, LPN

🔥 0 minutes ago

⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $29 - $35 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

👻 Ghost score 0%

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Maximus

WebsiteLinkedInAll Job Openings

10,000+ employees

🏛️ Government

🏥 Healthcare

💼 Consulting

💰 $7.9M Post-IPO Equity - Maximus on 2010-12

Government • Healthcare • Consulting

Maximus is a public-sector services firm that partners with government agencies to modernize and operate programs across health, human services, defense, national security, and civilian agencies. The company combines technology (AI, analytics, cloud, cybersecurity), omnichannel contact center and eligibility/enrollment systems, clinical and Medicaid enterprise services, and consulting and program-delivery capabilities to improve citizen experience and program outcomes. Backed by decades of government experience and scale, Maximus supports federal, state, and local clients with human-centered operational support and end-to-end digital modernization.

📋 Description

• Support the Colorado HMA (Health Maintenance Activities) Review Program • Complete desk-based clinical reviews to determine the appropriateness of recommended services • Support program goals and service level agreements (SLAs) • Participate in required trainings and meetings • Review service requests, including admissions, discharges, and continued stays, for adherence to clinical criteria, state and federal policy, and contract requirements • Apply clinical expertise to ensure consistency and quality outcomes; escalate policy exceptions • Issue approvals, denials, or recommendations based on contract requirements • Identify additional documentation or consultation needs and analyze information gaps • Document review activities accurately in contract systems • Communicate and collaborate with providers, individuals and designees, state workers, and external stakeholders • Provide guidance, coaching, training, and quality review for team members • Identify opportunities to improve review processes and consistency • Potentially meet with external clients to confirm and update internal clinical guidelines • Potentially write substantiated clinical determination reports synthesizing assessment findings, interview data, and supporting documentation

🎯 Requirements

• Associate degree in Nursing • Active LPN license in the state of Colorado or a compact license • 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 • 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 • Preferred: prior experience conducting document-based reviews • Preferred: excellent written and communication skills • Preferred: previous experience working remotely

🏖️ Benefits

• Work/life balance support and flexible work arrangements • Performance-based bonuses • Medical, dental, vision, prescription, and partially funded HSA plans • Life insurance benefits • Discounts on auto, home, renter's, and pet insurance • 401(k) retirement savings plan with company matching • Paid time off, holidays, and extended sick leave • Short- and long-term disability coverage • Employee Assistance Program (EAP) supporting physical, emotional, and financial wellness • Employee recognition platform • Tuition reimbursement • Employee perks and discounts • Maximus Wellness Program and resources • Professional development opportunities, including training programs, workshops, and conferences • Employer-paid renewal expenses for licenses and certifications • Company-issued computer equipment