Clinical Reviewer Registered Nurse (Remote)

About the Role

As a Clinical Reviewer, you will serve as a critical bridge between clinical expertise and regulatory 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, by issuing approvals, denials, or recommendations based on precise contract guidelines.

Beyond individual case reviews, you will play a mentorship role by providing training and consultation to assigned Clinical Reviewers. This position requires effective communication with healthcare providers, individuals, their designees, and state workers to facilitate necessary documentation and clinical consultations. You will operate within a structured environment where accuracy and adherence to Home and Community Based Services (HCBS) waivers are paramount.

Work Environment & Home Office

This is a remote position designed to support a secure and productive home office environment. Maximus provides company-issued computer equipment to ensure you have the necessary tools to perform your duties. To maintain operational efficiency and data security, a reliable high-speed internet connection is required, with minimum speeds of 20 Mbps download (50 Mbps for shared connectivity) and 5 Mbps upload. Candidates must also maintain a private and secure workspace.

Hiring Process & Accommodations

Maximus is committed to a fair and accessible employment process. We provide reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. 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.

Equal Opportunity Employer

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, and other legally protected characteristics. Our compensation philosophy is transparent and based on factors such as job location, education, training, experience, expected quality and quantity of work, required travel, and internal value analysis. We do not use an applicant's salary history in determining compensation and will comply with all regulatory minimum wage rates and exempt salary thresholds.