(Archived) Clinical Quality Analyst – Behavioral Health (Remote)

Maximus is currently looking for a Clinical Reviewer III to join our growing team. As a Clinical Reviewer you will review clinical documentation and requests submitted by individuals and/or providers to determine appropriate level of care and/or prior authorization.

The compensation for this position is $20-28 per hour. This is a work from home/remote position supporting the state of Maine in Eastern time zone.

Essential Duties and Responsibilities:

• Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements
• Issue approvals, denials or recommendations based on contract requirements
• Identify need for additional clinical documentation or consultation
• Complete documentation of activities within contract systems
• Communicate with providers, individuals and their designees, or state workers as required

Required Skills/Abilities:

• Knowledge and understanding of medical and/or behavioral health diagnoses and prescribed medications
• Ability to collect data, define problems, establish facts, and draw valid conclusions
• Excellent written and verbal communication skills
• Excellent interpersonal and customer service skills
• Proficient in Microsoft Office Suite
• Excellent organizational skills and attention to detail
• Ability to work in a fast-paced environment
• Ability to work independently and meet timelines

Education and Experience Requirements:

• Master’s degree in mental health, human services or related field
• Three (3) year of direct clinical experience with intellectual/developmental disabilities or mental health
  
  

Preferred Qualifications:

• Clinical or nursing licensure (LPC, RN, MHP, etc)
• Knowledge of community support programs, long-term care assessment and level of care in medical, behavioral health or related programs
• Experience/background with dementia population
• Experience in clinical assessment and/or reviewing
• PASRR experience highly desirable