Clinical Reviewer, LPN

Maximus

. Review requests for services, including admissions, discharges, and continued stays, for adherence to clinical criteria, state and federal policy, and contract requirements .

Posted 10/6/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $27 - $30 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical criteria adherence, documentation accuracy, and effective communication with healthcare providers. Proficient in conducting assessments and screenings while ensuring compliance with HIPAA and program standards.

Highest-signal resume keywords

Licensed Practical Nurse (LPN)Medical Nursing ExperienceMental Health ExperienceLevel I PASRR ScreeningsMS Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Criteria ReviewDocumentation AccuracyAssessment SynthesisInformation Gap AnalysisBehavioral Health EvaluationIntellectual/Developmental Disability KnowledgeContract ComplianceJudgment and AnalysisTyping Speed (35 WPM)Quality Outcome Recognition

Soft Skills

Effective CommunicationTeam CollaborationProblem SolvingAttention to DetailJudgment

Tools & Technologies

MS Office ApplicationsContract SystemsSecure Internet Service

Certifications & Qualifications

Licensed Practical Nurse (LPN) License

Industry Keywords

HIPAA ComplianceLong-Term Care ServicesClinical DocumentationState and Federal PolicyAdmissions and Discharges

About the role

Key responsibilities & impact

Review requests for services, including admissions, discharges, and continued stays, for adherence to clinical criteria, state and federal policy, and contract requirements
Escalate complex and non-standard cases that are exceptions to policies
Issue approvals, denials, or recommendations based on contract requirements
Apply judgment and analysis to interpret guidelines in non-routine cases
Identify the need for additional clinical documentation or consultation
Analyze information gaps to support accurate and timely determinations
Complete accurate documentation of review activities within contract systems
Communicate with providers, individuals and their designees, or state workers as required
Serve as an internal resource to team members within established processes
Write substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation
Complete summaries of findings
Conduct Level I PASRR screenings and evaluate behavioral health, intellectual/developmental disability, and medical information
Coordinate documentation with providers and monitor screening activities
Recognize trends and contribute to quality outcomes for individuals requiring long-term care services
Ensure compliance with HIPAA and program standards

Requirements

What you’ll need

High School Degree or equivalent required
Current and Active Licensed Practical Nurse (LPN) license in State of Illinois or Compact license
Minimum 2 years of experience in Medical Nursing and/or Mental Health
Proficiency in MS Office Applications such as Outlook, Excel, Power Point, and Word
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
Preferred: 4+ years of experience in Medical Nursing and/or Mental Health
Preferred: Prior Intellectual and Developmental Disabilities experience
Preferred: Prior experience with Level I PASRR screenings
Preferred: Ability to type at least 35 WPM

Benefits

Comp & perks

Work/life balance support
Performance-based bonuses
Medical, dental, vision, prescription insurance, and partially funded HSA
Life insurance
Auto, home, renter's, and pet insurance discounts
401(k) retirement savings plan with company matching
Paid time off, holidays, and extended sick leave
Short- and long-term disability coverage
Employee Assistance Program (EAP) supporting physical, emotional, and financial wellness
Employee recognition platform
Tuition reimbursement
Employee perks and discounts
Maximus wellness programs and resources
Professional development through training programs, workshops, and conferences
Employer-paid license and certification renewal expenses
Company-issued computer equipment