Clinical Reviewer
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Job Description
Clinical Reviewer evaluating Illinois Medicaid behavioral-health assessments for Maximus. Reviewing PASRR determinations, quality control, documentation, and service approvals remotely.
Responsibilities:
- Evaluate assessments and make determinations regarding individuals' needs for additional supports and services
- Conduct quality control reviews of field assessors' work to ensure accuracy and compliance
- Review routine service requests, including admissions, discharges, and continued stays, using established clinical criteria, state and federal policy, and contract requirements
- Escalate complex or non-standard cases outside defined protocols
- Issue approvals, denials, or recommendations based on contract requirements and standardized decision frameworks
- Identify needs for additional clinical documentation or consultation and seek guidance from senior staff
- Complete timely and accurate documentation of review activities in contract systems
- Communicate with providers, individuals and their designees, or state workers
- Write substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation, including summaries of findings
- Support the Illinois SALT program and assessment processes for PASRR Level I screens and Level II SMI evaluations
Requirements:
- High school diploma or GED required and 2+ years of relevant professional experience required, or equivalent combination of education and experience
- Master’s degree in counseling, social work, psychology, closely related field OR active, unrestricted RN license
- Minimum of two (2) years post-graduate work experience in the mental health field
- Minimum of two (2) years' experience conducting mental health assessments
- Proficiency in Microsoft Office applications
- Outstanding interpersonal and verbal communication skills
- Strong proficiency in written communication, producing concise and impactful documentation
- IM+CANS certification or willingness to obtain IM+CANS certification
- Strong computer skills
- Knowledge of PASRR
- Reliable high-speed internet service
- Minimum 20 Mbps download speeds/50 Mbps for shared internet connectivity
- Minimum 5 Mbps upload speeds
- Private and secure workspace
Benefits:
- Work/Life Balance Support and flexibility
- Performance-based bonuses
- Medical, Dental, Vision, Prescription insurance
- Partially funded HSA
- Life insurance benefits
- Auto, Home, Renter's, and Pet insurance discounts
- 401K Retirement Savings plan and Company Matching
- Paid time off, holidays, and extended sick leave
- Short- and Long-Term Disability coverage
- Employee Assistance Program (EAP) for physical, emotional, and financial wellness
- Recognition Platform
- Tuition Reimbursement
- Employee perks and discounts
- Maximus Wellness Program and Resources
- Professional Development Opportunities, including training programs, workshops, and conferences
- Company-issued computer equipment
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