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Clinical Reviewer LOC Child Assessments in Augusta, ME at Maximus, Inc.

Date Posted: 10/14/2018

Job Snapshot

  • Employee Type:
  • Location:
    Augusta, ME
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Position Based in Maine

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
  •  Responsible for engagement and performance feedback for Assessors, including onboarding assistance, making/following up on referrals, tracking responsiveness, and informing both Recruiting and Credentialing and supervisor in writing when performance and/or responsiveness issues arise with any Assessor
  • 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
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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