[Remote] Clinical Reviewer RN (Remote in TN)

Note: The job is a remote job and is open to candidates in USA. Maximus is seeking a Clinical Reviewer (Registered Nurse) to support the Tennessee Appeals area of the contract. In this role, the RN Clinical Reviewer is responsible for reviewing clinical cases, applying nursing judgment and regulatory guidelines, and ensuring each case is accurately assessed and routed to the appropriate department or escalated as needed. 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 • Performs other related duties as assigned Skills • Current Registered Nurse (RN) license valid in the state of practice is required • High School Degree or equivalent required • Minimum 2 years of clinical experience required • Minimum of one (1) year of registered nurse experience • Knowledge of mental health principles and practices • Experience in physical rehabilitation • Attention to detail Benefits • Work/Life Balance Support - Flexibility tailored to your needs! • Competitive Compensation - Bonuses based on performance included! • Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance. • Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching. • Paid Time Off Package – Enjoy PTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage. • Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP). • Recognition Platform - Acknowledge and appreciate outstanding employee contributions. • Tuition Reimbursement - Invest in your ongoing education and development. • Employee Perks and Discounts - Additional benefits and discounts exclusively for employees. • Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs. • Professional Development Opportunities-Participate in training programs, workshops, and conferences. • Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees. Company Overview • Providing government technology services, digitally enabled customer experiences, and clinical health services that change lives. It was founded in 1975, and is headquartered in Mclean, Virginia, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship • Maximus has a track record of offering H1B sponsorships, with 39 in 2025, 39 in 2024, 50 in 2023, 42 in 2022, 36 in 2021, 42 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job