Clinical Reviewer, LPN

This is a fully remote position, open to applicants in Colorado.

📋 Description

• Assist in the Colorado Health Maintenance Activities (HMA) Review Program.

• Conduct desk-based clinical assessments to evaluate the appropriateness of recommended services.

• Aid in achieving program objectives and meeting service level agreements (SLAs).

• Attend necessary training sessions and meetings.

• Review service requests, such as admissions, discharges, and ongoing stays, for compliance with clinical criteria, state and federal regulations, and contractual obligations.

• Utilize clinical knowledge to ensure consistent and high-quality outcomes; escalate any policy exceptions as needed.

• Provide approvals, denials, or recommendations in accordance with contract stipulations.

• Identify needs for additional documentation or consultations and evaluate information deficiencies.

• Accurately document review processes in contract management systems.

• Engage and collaborate with providers, individuals and their designees, state personnel, and external stakeholders.

• Offer guidance, coaching, training, and quality assessments to team members.

• Recognize opportunities for enhancing review processes and ensuring consistency.

• Potentially meet with external clients to verify and update internal clinical guidelines.

• Possibly draft comprehensive clinical determination reports that summarize assessment findings, interview data, and supporting documents.

⛳️ Requirements

• An associate degree in Nursing.

• A valid LPN license in the state of Colorado or a compact license.

• At least 2 years of experience working with individuals who have complex disabilities, including pediatric and geriatric populations.

• Knowledge of Home and Community-Based Services waivers (HCBS).

• Proficient in Microsoft Office applications.

• Access to reliable high-speed internet service.

• Minimum download speeds of 20 Mbps / 50 Mbps for shared internet connections.

• Minimum upload speeds of 5 Mbps.

• A private and secure workspace.

• Preferred: Experience with document-based reviews.

• Preferred: Strong written and communication skills.

• Preferred: Previous experience in a remote work setting.

🏝️ Benefits

• Support for work/life balance and flexible working arrangements.

• Bonuses based on performance.

• Medical, dental, vision, prescription, and partially funded HSA plans.

• Life insurance benefits.

• Discounts on auto, home, renter's, and pet insurance.

• 401(k) retirement savings plan with company matching.

• Paid time off, holidays, and extended sick leave.

• Coverage for short- and long-term disabilities.

• Employee Assistance Program (EAP) promoting physical, emotional, and financial wellness.

• Employee recognition platform.

• Tuition reimbursement options.

• Employee perks and discounts.

• Maximus Wellness Program and resources.

• Opportunities for professional development, including training programs, workshops, and conferences.

• Employer-paid renewal fees for licenses and certifications.

• Company-provided computer equipment.