Maximus

Assessor

• Conduct person-centered clinical assessments according to contract directives, company processes, and contract requirements
• Evaluate individuals in homes, group homes, and care facilities to determine Long Term Care needs and appropriate placement options
• Complete routine medical and/or behavioral health assessments using standardized tools and criteria
• Escalate complex or non-standard cases outside defined protocols
• Conduct on-site, video, and/or telephonic assessments to determine service and support needs, eligibility, and level of care
• Perform duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies
• Ensure accurate and consistent documentation of assessment outcomes
• Travel to client, consumer, or program locations to perform in-person assessments exceeding 50% of the workweek

RN Clinical Assessor

Administration

• Support the Kansas Home and Community-Based Services (HCBS) Program
• Schedule assessments and accommodations for the population served
• Respond to phone and email inquiries within contractual turnaround times
• Provide high-level customer support to internal and external customers
• Perform data entry
• Research and resolve discrepancies with provider documents
• Review information keyed into the system to verify data accuracy
• Monitor data/image quality of scanned documents
• Follow established policies and procedures for indexing and imaging without deviation
• Maintain confidentiality and security of relevant information

Clinical Administrator

Medical Reviewer

• Evaluate assessments and make determinations regarding individuals' needs for additional supports and services
• Conduct quality control reviews of field assessors' work to ensure accuracy and compliance
• Review routine service requests, including admissions, discharges, and continued stays, using established clinical criteria, state and federal policy, and contract requirements
• Escalate complex or non-standard cases outside defined protocols
• Issue approvals, denials, or recommendations based on contract requirements and standardized decision frameworks
• Identify needs for additional clinical documentation or consultation and seek guidance from senior staff
• Complete timely and accurate documentation of review activities in contract systems
• Communicate with providers, individuals and their designees, or state workers
• Write substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation, including summaries of findings
• Support the Illinois SALT program and assessment processes for PASRR Level I screens and Level II SMI evaluations

Clinical Reviewer

Nurse

• Complete medical and/or behavioral health assessments
• Conduct on-site, video, and/or telephonic assessments to determine needs, eligibility, and level of care
• Interpret clinical and program guidelines for accurate determinations
• Comply with Person First standards, HIPAA guidelines, and confidentiality policies
• Serve as an internal resource to team members
• Travel to client, consumer, or program locations for in-person assessments exceeding 50% of the workweek
• Use standardized tools (UCA, TTT) to identify medical, functional, and social needs
• Develop and manage service plans for complex or high-acuity members
• Coordinate with healthcare providers, case managers, and community resources
• Evaluate eligibility for referrals to professionals or agencies
• Maintain compliance with state and federal regulations, Medicaid/LTSS guidelines, and electronic health record systems
• Revise care plans with care teams as member needs change
• Educate members, families, and caregivers on available services and options
• Document assessments and care activities for billing, compliance, and quality reporting
• Advocate for members to remain in preferred living environments and maintain independence

Field Registered Nurse

Bilingual

• Provide advanced clinical inquiry responses, verbally and in writing, to consumers, educators, and medical/health professionals
• Provide medical subject matter expertise
• Perform advanced database searches
• Compose documents, reports, and correspondence
• Document all incoming inquiries
• Participate in special projects as required
• Support CDC INFO, the CDC’s national contact center, via phone, email, and chat

RN Clinical Assessor

Clinical Administrator

Clinical Reviewer

Field Registered Nurse

Bilingual Health Specialist, RN