Clinical Reviewer Registered Nurse (Remote)
Not Disclosed•Full-TimeRemote
location_on79, Pennington Street, The Ironbound, Newark, Essex County, New Jersey, 07105, United States
About the Role
As a Clinical Reviewer, you will serve as a critical bridge between clinical expertise and administrative compliance. In this position, you will review service requests—including admissions, discharges, and continued stays—to ensure strict adherence to clinical criteria, state and federal policies, and contract requirements. Your work directly impacts the continuity of care for individuals with complex disabilities, including pediatric and geriatric populations.
You will exercise your clinical judgment to issue approvals, denials, or recommendations based on contract guidelines. When gaps in information arise, you will identify the need for additional clinical documentation or consultation. Beyond individual case reviews, you will play a key role in supporting your team by providing training and consultation to assigned Clinical Reviewers. This role requires clear, professional communication with healthcare providers, individuals, their designees, and state workers to facilitate seamless care coordination.
Work Environment & Home Office
This is a remote position designed for professionals who thrive in a structured, independent environment. Maximus provides company-issued computer equipment to ensure you have the necessary tools to succeed. To maintain the security and efficiency required for handling sensitive health data, you must have a reliable high-speed internet connection (minimum 20 Mbps download/50 Mbps for shared connectivity, and 5 Mbps upload) and a private, secure workspace.
Hiring Process
Candidates selected for this role will undergo a standard employment process. If you require assistance at any stage—including accessing job postings, completing assessments, or participating in interviews—please contact People Operations at applicantaccom@maximus.com to request reasonable accommodations.
Equal Opportunity & Compensation
Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information, or other legally protected characteristics.
Our compensation philosophy is comprehensive. While annual salary is a key component, Maximus offers a total rewards package that includes short- and long-term incentives, program-specific awards, health insurance, life and disability insurance, a retirement savings plan, and paid time off. Compensation is determined by factors such as job location, education, experience, and market value, and is commensurate with job duties and relevant work experience. We do not use an applicant's salary history to determine compensation and will comply with all regulatory minimum wage rates and exempt salary thresholds.
Work location
Work model: Remote
79, Pennington Street, The Ironbound, Newark, Essex County, New Jersey, 07105, United States
Newark, New Jersey
Key Responsibilities
- check_circleReview service requests for adherence to clinical criteria and policy
- check_circleIdentify need for additional clinical documentation or consultation
- check_circleComplete documentation of activities within contract systems
- check_circleProvide training and consultation to assigned Clinical Reviewers
- check_circleIssue approvals, denials, or recommendations based on contract requirements
- check_circleCommunicate with providers, individuals, and state workers as required
Requirements
- verifiedCurrent Registered Nurse (RN) license valid in the state of practice
- verifiedHigh School Degree or equivalent
- verifiedMinimum 2 years of clinical experience
- verifiedAssociate degree in Nursing
- verifiedActive RN license in Colorado or compact license
- verifiedMinimum 2 years experience with complex disabilities
- verifiedFamiliarity with Home and Community Based Services waivers (HCBS)
- verifiedProficiency in Microsoft Office applications
Nice to Have
Prior experience conducting document-based reviews. Excellent written and communication skills. Previous experience working remotely.
Benefits & Perks
check_circleHealth insurance coveragecheck_circleLife and disability insurancecheck_circleRetirement savings plancheck_circlePaid holidays and paid time offCompany-issued computer equipment for home office
