Quality Clinical Reviewer

🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $70.7k - $113.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Magellan Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $101M Private Equity Round on 2004-01

Consulting • Insurance • Healthcare

Magellan Health is a leading healthcare management company that provides a range of services, including behavioral health, pharmacy management, and employee assistance programs. The company focuses on delivering high-quality care and support to individuals and families, particularly those in military and community settings. Magellan Health emphasizes personalized service and innovative solutions to improve health outcomes and enhance the overall patient experience.

📋 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 internal and external stakeholders • Provide clinical reviews of 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 assistance from the Reporting and Analytics unit • Present findings at provider and customer meetings as needed • Assist with planning and implementing service-delivery and quality-of-care improvement activities • Develop and coordinate in-service education programs for providers and care managers • 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 plus 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 treatment modalities • Knowledge of psychopharmacology • Knowledge of federal and state regulatory guidelines • Experience with performance measurement • Ability to work independently with minimal supervision • Project management skills and demonstrated experience • Required licenses/certifications include LCSW, LMHC, LPC, MFT, PSY, RN, and applicable state and/or compact-state licensure as relevant to the clinician pathway • Must comply with applicable legal, regulatory, contractual, security and internal policy requirements

🏖️ Benefits

• Base salary range of $70,715-$113,145 • Potential eligibility for short-term incentives • Comprehensive benefits package • Health, life, voluntary and other benefits • Physical, mental, emotional and financial wellbeing perks • Professional growth and development • Total health and wellness • Rewards and recognition • Employee unity • Tobacco-free workplace