Clinical Reviewer, LPN

🔥 17 hours ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $26 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

🚫👨‍🎓 No degree required

👻 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

• Review requests for services, including admissions, discharges, and continued stays, for adherence to clinical criteria, state and federal policy, and contract requirements • Escalate complex and non-standard cases that are exceptions to policies • Issue approvals, denials, or recommendations based on contract requirements • Apply judgment and analysis to interpret guidelines in non-routine cases • Identify the need for additional clinical documentation or consultation • 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 • Write substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation • Complete summaries of findings • Conduct Level I PASRR screenings and evaluate behavioral health, intellectual/developmental disability, and medical information • Coordinate documentation with providers and monitor screening activities • Recognize trends and contribute to quality outcomes for individuals requiring long-term care services • Ensure compliance with HIPAA and program standards

🎯 Requirements

• High School Degree or equivalent required • Current and Active Licensed Practical Nurse (LPN) license in State of Illinois or Compact license • Minimum 2 years of experience in Medical Nursing and/or Mental Health • Proficiency in MS Office Applications such as Outlook, Excel, Power Point, and Word • 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: 4+ years of experience in Medical Nursing and/or Mental Health • Preferred: Prior Intellectual and Developmental Disabilities experience • Preferred: Prior experience with Level I PASRR screenings • Preferred: Ability to type at least 35 WPM

🏖️ Benefits

• Work/life balance support • Performance-based bonuses • Medical, dental, vision, prescription insurance, and partially funded HSA • Life insurance • Auto, home, renter's, and pet insurance discounts • 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 programs and resources • Professional development through training programs, workshops, and conferences • Employer-paid license and certification renewal expenses • Company-issued computer equipment