Clinical Quality Assurance Analyst - (Remote, US)

Maximus is hiring a Clinical Quality Assurance Analyst to join our team and play a vital role in maintaining the accuracy, consistency, and compliance of clinical assessments. In this role, you will conduct quality assurance reviews for PASRR assessments and Home and Community-Based Services (HCBS) Waivers, ensuring all evaluations align with regulatory and program requirements. You will identify discrepancies, provide feedback, and help uphold the highest standards of clinical quality.

If you have a keen eye for detail, a strong clinical background, and a passion for quality assurance, we encourage you to apply and make a meaningful impact!

About the programs:  

Our Home and Community-Based Services (HCBS) program provides essential care and assistance to individuals with disabilities, seniors, and those in need of daily living support. We are dedicated to promoting independence, dignity, and quality of life by delivering personalized services that help individuals thrive in community settings. This role is part of a collaborative remote team and will focus on conducting quality assurance audits.

Maximus is contracted with Colorado Department of Health Care Policy and Financing to manage the statewide CO PASRR program. Managing submission of all Level I PASRR referrals and Status Changes, completion of clinical review to determine if a person has a known or suspected PASRR condition (SMI, ID or related condition), completion of the comprehensive person-centered Level II assessments. This role will be part of a collaborative remote team of professionals and will be responsible for conducting quality assurance audits across the entire PASRR process.

Why Maximus?

• 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 Unlimited Time Off (UTO), 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 it

Essential Duties and Responsibilities:

• Collaborates with the Clinical Operation Manager to develop an effective quality monitoring program
• Provides QA training to the Clinical Assessors, Clinical Monitors, and the QA staff in order that quality actions are incorporated into their daily practice
• Collects data related to assessments and assessment outcomes
• Examines cases at random for completeness, accuracy and consistency
• Examines data for outliers and researches such cases
• Analyzes recommended scores in relation to Nurse Assessor determinations
• Develops / completes reports that track and trend activities / outcomes
• Acts as an advisor to program staff on all QA and Compliance issues related to the program
• Attends Fair Hearing cases and prepare case packets, as required
• Performs other duties as may be assigned

Minimum Requirements:

• Master’s Degree from a Nurse Practitioner or Physician Assistant Program required
• Licensed Nurse Practitioner or Physician Assistant required
• Preferred Specialties for Nurse Practitioners: Internal Medicine, Adult Health, Community Health, Family Practice, Psychiatry
• Two (2) or more years practicing experience as a Nurse Practitioner / Physician Assistant required
• 2+ years previous work experience in Quality and Risk Management in a hospital setting conducting peer reviews preferred
• Strong working ability with all forms of technology, ability to navigate multiple systems, intermediate knowledge of Microsoft Office programs, ability to learn and adapt to new technology quickly; exceptional analytical skills; detail and solution-oriented; ability to work independently as well as with a team; excellent verbal and written communication skills including the ability to communicate effectively with a diverse range of individuals

Preferred Skills and Qualifications:

• Masters degree in human services or related field 
• At least 3 years of experience working with mental health assessments or waiver programs

Preferred Requirements :

• Previous experience performing QA for mental health or medical assessments

Home Office Requirements:

• Maximus provides company-issued computer equipment 
• Reliable high-speed internet service 
• Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity 
• Minimum 5 Mpbs upload speeds 
• Private and secure workspace