Clinical Reviewer - (Remote)

Description & Requirements

Maximus is hiring a Clinical Reviewer to support the Illinois SALT program. The Clinical Reviewer is responsible for evaluating assessments and making determinations regarding individuals' needs for additional supports and services. This role includes conducting quality control reviews of field assessors' work to ensure accuracy and compliance. Training Schedule: - Monday to Friday, 8:00 AM - 5:00 PM CST Post-Training Work Schedule: - Thursday to Sunday, 8:00 AM - 6:30 PM CST About the program We have contracted with the State of Illinois Department of Healthcare and Family Services (HFS) to manage the assessment process for Preadmission Screening and Resident Review (PASRR) Level I screens and completing Level II Serious Mental Illness (SMI) evaluations for individuals applying to, or residing in, Medicaid-certified nursing facilities. Other services include Follow Up Visits; admissions support for Specialized Mental Health Rehabilitation Facilities (SMHRF) and Supported Living Programs (SLP) settings and Colbert Dementia Review. Continues to expand assessment services in the state. 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.

Essential Duties and Responsibilities: - Review service requests that are typically routine, including admissions, discharges, and continued stays, using established clinical criteria, state and federal policy, and contract requirements; escalate complex or non-standard cases that fall outside defined protocols. - Issue approvals, denials, or recommendations based on contract requirements and standardized decision frameworks. - Identify the need for additional clinical documentation or consultation and seek guidance from senior staff as appropriate. - Complete timely and accurate documentation of review activities within contract systems in accordance with established procedures. - Communicate with providers, individuals and their designees, or state workers as required. - May write high-quality, fully substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation, including completing the summary of findings.

- 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 must have an 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 Preferred Requirements: - Demonstrates outstanding interpersonal