Remote Clinical Reviewer, RN or LPN – Tennessee

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.

– 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

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

Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Maximus compensation is based on various factors including but not limited to job location, a candidate’s education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus’s total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant’s salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process—including accessing job postings, completing assessments, or participating in interviews,—please contact People Operations at applicantaccom@maximus.com.