Description

Maximus is seeking a Clinical Reviewer (RN) supporting the Colorado HMA (Health Maintenance Activities) Review Program. This role requires completion of desk based clinical reviews to determine appropriateness of recommended services, supports program goals and service level agreements (SLAs).  The reviewer must participate in all required trainings and meetings, in addition to other tasks as required by their supervisor.

**Position is contingent upon contract award**

Work Schedule: This position is scheduled Monday through Friday from 8:00 a.m. to 5:00 p.m. Mountain Time with some weekend coverage required based on business needs.

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.
• Provide training and/or consultation to assigned Clinical Reviewers.
• Performs other related duties as assigned.

Minimum Requirements

• Current Registered Nurse (RN) license valid in the state of practice is required
• High School Degree or equivalent required
• Minimum 2 years of clinical experience required
• Associate degree in Nursing
• An active RN (Registered Nurse) license in the state of Colorado or a compact license is required
• Minimum 2 years of experience working with people with complex disabilities, including pediatric and geriatric populations
• Familiarity with Home and Community Based Services waivers (HCBS)
• Proficiency in Microsoft Office applications

Preferred Requirements:

• Prior experience conducting document-based reviews
• Excellent written and communication skills
• Previous experience working remotely
• Prior experience conducting document-based reviews

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