Clinical Reviewer LPN - (Remote)

Maximus

1d•$27 - $30•Remote

About The Position

Join Maximus as a Clinical Reviewer (LPN) and play a vital role in supporting the Illinois SALT (Screening Assessment for Long-Term Settings) program. In this fully remote position, you will help ensure individuals receive the appropriate level of care by reviewing clinical documentation, conducting Level I PASRR screenings, and evaluating behavioral health, intellectual/developmental disability, and medical information to support informed clinical decisions. The role involves reviewing screening cases, coordinating documentation with providers, identifying situations requiring further evaluation, and ensuring compliance with HIPAA and program standards. As a member of a collaborative clinical team, you will partner with healthcare providers, monitor screening activities, recognize trends, and contribute to quality outcomes for individuals requiring long-term care services. If you are a licensed nurse with strong clinical judgment, attention to detail, and a passion for improving healthcare outcomes, we encourage you to apply. About The Program: We have contracted with the State of Illinois Department of Healthcare and Family Services (HFS) to manage the assessment process for Preadmission Screening and Resident Review (PASRR) Level I screens and completing Level II Serious Mental Illness (SMI) evaluations for individuals applying to, or residing in, Medicaid-certified nursing facilities. Other services include Follow Up Visits, admissions support for Specialized Mental Health Rehabilitation Facilities (SMHRF) and Supported Living Programs (SLP) settings and Colbert Dementia Review.

Requirements

Specific clinical license and experience requirements based on contract 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 Mpbs download speeds/50 Mpbs for shared internet connectivity
Minimum 5 Mpbs upload speeds
Private and secure workspace

Nice To Haves

4+ years of experience in Medical Nursing and/or Mental Health
Prior Intellectual and Developmental Disabilities experience
Prior experience with Level I PASRR screenings
Effective communication skills and ability to follow directions
Ability to interact courteously and effectively with a variety of people
Ability to handle pressure and perform multiple tasks
Must be able to (at minimum) type 35 WPM

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.

Benefits

Flexibility tailored to your needs!
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.
Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage.
Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
Acknowledge and appreciate outstanding employee contributions.
Invest in your ongoing education and development.
Additional benefits and discounts exclusively for employees.
Access a range of wellness programs and resources tailored to your needs.
Participate in training programs, workshops, and conferences.
Maximus assumes the expenses associated with renewing licenses and certifications for its employees.