• Clinical Reviewer LPN

    Job Locations US-ME-Augusta
    Posted Date 1 week ago(11/6/2018 5:28 PM)
    Requisition ID
    # of Openings
    Job Function
    Case Management
    Job Schedule
    Regular Full-Time
  • Responsibilities

    Position is based in Maine.
    Perform document-based and telephonic utilization review for contracted services; screening for diagnosis or suspicion of serious mental illness and or intellectual disability, medical necessity for short or long term nursing facility placement, targeted review of disability services received in an NF, and long term care requirements for children in foster care

    The Ideal Candidate will Possess the Following Additional Education and Experience

    • Performs desk-based quality review for functional eligibility assessments, including Long Term Care, (all those
    • Listed in RFP)
    • Conducts telephonic and document-based utilization review that adheres to state directed clinical criteria for determining medical need
    • Attends and participates in scheduled contract, committee, and all-staff meetings
    • Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures
    • Excellent knowledge of diverse cultures and issues, with the ability to incorporate special needs into utilization review decisions
    • Working knowledge and understanding of behavioral health diagnoses, psychotropic medications, medical diagnoses and prescribed medications
    • Excellent ability to multitask while effectively performing job duties, which include prioritizing tasks; ensure all

      voice mail and email messages are monitored and responded to within 2 business hours of receipt

    • Ability to work independently, as well as within a team while exhibiting excellent interpersonal skills
    • Excellent written and verbal communication skills
    • Ability to interact professionally and collegially with providers (hospital & nursing facility, physicians, community service workers, etc.), state contract officers, and coworkers while seeking or providing information
    • Ability to collect data, define problems, establish facts, and draw valid conclusions for supporting a superior written rationale for review determination
    • Excellent computer skills with experience in word processing, email and spreadsheets {Microsoft Word, Outlook and Excel preferred); ability to work with dual computer monitors, research information on the internet, utilize company resources/ tools stored on company
    • PASRR Level One Reviewer - LPN with current licensure in the state of Maine.
    • LOC Child Assessments Reviewer - Bachelor's degree in Social Services, and one (1) experience working with children required. Complete a Level of Care (LOQ Child Assessment for each child in a Foster Care placement for Foster Care rate setting purposes. Be responsible for: 1) receiving referrals for LOC Child Assessments from the Departmetn;2) reviewing case documentation provided by OCFS; 3) completing the CAFAS/PECFAS online tool as required (based on the child's age on the provided records);4) completing the Resource Parent/Family phone interview by using the Department's Caregiver Questionnaire; and 5) completing the LOC Child Assessment within thirty (30) days of receiving the referral.

    EEO Statement

    EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. MAXIMUS is an Affirmative Action/Equal Opportunity Employer. MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.


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