Description

Maximus is hiring a Clinical Reviewer, RN/LPN to support the Tennessee Katie Beckett Program. In this role, you will review clinical documentation, medical records, assessments, and supporting information to help determine program eligibility for children with significant disabilities or complex medical needs. You will evaluate medical, behavioral, and functional information to ensure accurate and timely eligibility determinations in accordance with program requirements and state guidelines.

**This is a remote position; candidates must reside in Tennessee.

This position plays a key role in helping eligible children and their families access healthcare coverage, home and community-based services, and other critical supports that enable children to remain safely at home and actively participate in their communities. The Clinical Reviewer ensures clinical reviews are completed accurately, consistently, and in compliance with Tennessee Katie Beckett Program policies and regulatory requirements.

About the Program:
Tennessee's Katie Beckett Waiver Program is for children under the age of 18 with disabilities or complete medical needs, who are not Medicaid eligible because of their parent's income or assets. This program will provide services and/or help pay for medical care that private insurance does not cover, and has two parts: Part A and Part B. TennCare has partnered with Maximus to complete face-to-face Part A assessments utilizing a Qualified Intellectual Disability Professional (QIDP),Qualified Mental Health Professional (QMHP), and/or Registered Nurse (RN). 

Why Maximus?

• Work/Life Balance Support - Flexibility tailored to your needs!
• Competitive Compensation - 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.
• Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching.
• Paid Time Off Package - Enjoy PTO, Holidays, and extended sick leave, along with Short- and Long-Term Disability coverage.
• Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).
• Recognition Platform - Acknowledge and appreciate outstanding employee contributions.
• Tuition Reimbursement - Invest in your ongoing education and development.
• Employee Perks and Discounts - Additional benefits and discounts exclusively for employees.
• Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs.
• Professional Development Opportunities-Participate in training programs, workshops, and conferences.
• Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees.

Essential Duties and 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.

Minimum Requirements:

• Education and licensure requirements are based on program contract requirements and are outlined in job posting
• High School Degree or equivalent required
• Minimum 2 years of clinical experience required
• Current and valid Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in the state of Tennessee.
• Minimum of two (2) years of clinical experience in a Registered Nurse (RN) or Licensed Practical Nurse (LPN) position.
• Proficiency in Microsoft Office Suite (Word, Outlook, Excel), Adobe
• Strong clinical assessment, critical thinking, documentation skills, and the ability to apply clinical judgment accurately in a fastpaced environment.
• Strong written and verbal communication skills.

Preferred Requirements:

• Experience in care management and documenting clinical reviews.
• Proficiency with electronic medical records and clinical documentation systems.

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