Quality Clinical Reviewer

🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $70.7k - $113.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Magellan Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $101M Private Equity Round - Magellan Health Services on 2004-01

Healthcare • Healthcare Insurance

Magellan Health is a healthcare organization focused on behavioral health and care-management services. The company provides clinical care managers, military and family life counselors, and behavioral health services across regional programs (e. g. , Magellan Hawai‘i, Magellan of New Mexico), and supports treatment coordination for mental health and substance abuse conditions. It also offers programs that support military families and other institutional clients, indicating work in managed behavioral health and care coordination.

📋 Description

• Conduct reviews of clinical interactions and clinical documentation, including case management records and provider treatment records • Collect data using established procedures and analyze findings for continuous quality improvement and internal and external reporting • Interact with multiple internal and external stakeholders • Review Quality of Care and Critical/Adverse incidents related to clinical services • Audit case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards, and contract requirements • Review provider treatment records against established clinical and procedural standards • Monitor quality-of-care standards across the participating provider network and care managers • Evaluate patient safety risk and determine follow-up actions according to policies • Prepare clinical record information for projects assessing the efficiency, effectiveness, and quality of managed care services • Prepare monthly performance reports with the Reporting and Analytics unit and present findings at provider and customer meetings • Assist with planning and implementing service-delivery and quality-of-care improvement activities, including in-service education programs • Audit and validate internal audit results and corrective action plans

🎯 Requirements

• Bachelor's level clinician (RN) or master's level clinician (LCSW, LPC, LMHC, MFT) required • 5+ years of clinical experience required • 7 or more years of clinical experience with an associate's degree and RN licensure may substitute for the bachelor's degree and RN licensure • Experience with total quality improvement or behavioral healthcare backgrounds in treatment modalities, psychopharmacology, federal/state regulatory guidelines, and performance measurement • Ability to work independently with minimal supervision • Project management skills and demonstrated experience • Required licensure/certification: LCSW, LMHC, LPC, MFT, PSY, or RN state and/or compact-state licensure

🏖️ Benefits

• Short-term incentives may be available • Comprehensive benefits package • Health, life, voluntary, and other benefits and perks • Benefits supporting physical, mental, emotional, and financial wellbeing • Tobacco-free workplace