Description

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 Medicaidcertified nursing homes. 

About the Program

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.

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
• An active unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license valid in Tennessee state or a compact nursing license with Tennessee privileges
• 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 navigating and documenting clinical reviews within utilization management or authorization database platforms (e.g., Legacy AMI or similar systems)
• Proficiency with electronic medical records and clinical documentation systems
• Prior utilization review, care management, or clinical review experience
• Candidates who reside in Tennessee state

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