Clinical Reviewer, LPN

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

📋 Description

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

• Elevate complex and atypical cases that deviate from established policies.

• Make decisions on approvals, denials, or recommendations in accordance with contractual stipulations.

• Utilize judgment and analytical skills to interpret guidelines in non-standard scenarios.

• Determine the necessity for additional clinical documentation or consultations.

• Examine information gaps to facilitate accurate and prompt decision-making.

• Maintain precise documentation of review processes within contractual systems.

• Engage with providers, individuals and their representatives, or state personnel as needed.

• Act as a resource for team members within defined procedures.

• Prepare well-supported clinical determination reports by integrating assessment findings, interview data, and relevant documentation.

• Compile summaries of findings.

• Perform Level I PASRR screenings and assess behavioral health, intellectual/developmental disabilities, and medical data.

• Coordinate documentation with providers and oversee screening processes.

• Identify trends and contribute to quality outcomes for individuals in need of long-term care services.

• Ensure adherence to HIPAA regulations and program standards.

⛳️ Requirements

• High School Diploma or equivalent is mandatory.

• Current and active Licensed Practical Nurse (LPN) license in the State of Illinois or a Compact license is required.

• A minimum of 2 years of experience in Medical Nursing and/or Mental Health is necessary.

• Proficiency in MS Office Applications, including Outlook, Excel, PowerPoint, and Word.

• 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 is essential.

• Preferred: 4+ years of experience in Medical Nursing and/or Mental Health.

• Preferred: Previous experience with Intellectual and Developmental Disabilities.

• Preferred: Experience in conducting Level I PASRR screenings.

• Preferred: Ability to type at least 35 WPM.

🏝️ Benefits

• Support for work/life balance.

• Performance-based bonuses.

• Comprehensive medical, dental, vision, and prescription insurance, along with a partially funded HSA.

• Life insurance coverage.

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

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

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

• Coverage for short- and long-term disability.

• Employee Assistance Program (EAP) focusing on physical, emotional, and financial well-being.

• Platform for employee recognition.

• Tuition reimbursement opportunities.

• Employee perks and discounts available.

• Maximus wellness programs and resources.

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

• Employer-covered license and certification renewal costs.

• Provision of company-issued computer equipment.