JOB DESCRIPTION SUMMARY

Perform document-based and telephonic utilization review for contracted services; screening for diagnosis or suspicion of serious mental illness and or intellectual disability, and medical necessity for short or long term nursing facility placement.

JOB SUMMARY

Essential Duties and Responsibilities:

• Responsible for pre-admission and concurrent reviews for admissions and continued placement in Medicaid certified nursing facilities, utilizing federal and State's criteria
• Review and communicate all information with providers, utilizing computer database system for determining nursing facility placement appropriateness
• Utilize both referral screens and medical records review to make determinations
• Develop and document a clinical rationale supporting the review decision as the final step in the review process. Must work within a tight turnaround time assuring contract compliance
• Complete other job duties as assigned or necessary Minimum Requirements:
• Graduation from an accredited school of nursing, with current RN or LPN, or a MSW, or related license, in good standing, as dictated by the client contract.Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures
• At least two (2) years of experience working with individuals with a mental health diagnosis and/or intellectual disability, with the primary focus on behavioral health, as dictated by the client contract. In addition, candidates must have a minimum of two (2) years of medical experience with a strong understanding of rehabilitation potential, based on diagnosis, age, disease process and chronicity also as dictated by the client contract
• 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 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 with providers (hospital & nursing home staff, 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 sites

MAXIMUS INTRODUCTION

Since 1975, Maximus has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. Maximus delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, Maximus is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

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.

As a leading strategic partner to governments across the globe, Maximus helps improve the delivery of public services amid complex technology, health, economic, environmental, and social challenges. With a deep understanding of program service delivery, acute insights that achieve operational excellence, and an extensive awareness of the needs of the people being served, our employees advance the critical missions of our partners. Maximus delivers innovative business process management, impactful consulting services, and technology solutions that provide improved outcomes for the public and higher levels of productivity and efficiency of government-sponsored programs.