Magellan Health
Quality Clinical Reviewer - Remote
Magellan Health, Honolulu, Hawaii, United States, 96814
Quality Clinical Reviewer - RemoteApply locations: Remote HI Honolulu 96813
Time type: Full time
Posted on: Posted 15 Days Ago
Job requisition id: R00000063993
Conducts reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records. Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services.
Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
Reviews provider treatment records against clinical and procedural established standards.
Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.
Conducts reviews of Quality of Care and Critical/Adverse Incidents.
Evaluates level of patient safety risk and need for follow-up actions per policies.
Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services.
Prepares monthly performance reports with assistance from Reporting and Analytics unit. Presents findings at provider and customer meetings as needed.
Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers.
Responsible for auditing as well as validating internal audit results and/or corrective action plans.
Other Job Requirements
Responsibilities
Bachelor's level clinician (RN) or master's level clinician (LCSW, LPC, LMHC, MFT) required.
5+ years of clinical experience required.
Will substitute 7 or more years of clinical experience along with an associate's degree and RN licensure in place of the bachelor's degree and RN licensure.
Experience working with total quality improvement or a behavioral healthcare background in treatment modalities, psychopharmacology, federal/state regulatory guidelines, performance measurement.
Ability to work independently with minimal supervision.
Project management skills and demonstrated experience.
General Job Information
Title:
Quality Clinical Reviewer - Remote
Grade:
25
Work Experience - Required:
Clinical
Work Experience - Preferred:
Quality
Education - Required:
A Combination of Education and Work Experience May Be Considered. - Nursing, Bachelor's - Nursing, Master's - Behavioral Health
Education - Preferred:
PsyD - Clinical Psychology
License and Certifications - Required:
LCSW, LMHC, LPC, MFT, PSY, RN - State and/or Compact State Licensure
Salary Range
Salary Minimum: $64,285
Salary Maximum: $102,855
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
About UsMagellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
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Time type: Full time
Posted on: Posted 15 Days Ago
Job requisition id: R00000063993
Conducts reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records. Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services.
Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
Reviews provider treatment records against clinical and procedural established standards.
Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.
Conducts reviews of Quality of Care and Critical/Adverse Incidents.
Evaluates level of patient safety risk and need for follow-up actions per policies.
Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services.
Prepares monthly performance reports with assistance from Reporting and Analytics unit. Presents findings at provider and customer meetings as needed.
Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers.
Responsible for auditing as well as validating internal audit results and/or corrective action plans.
Other Job Requirements
Responsibilities
Bachelor's level clinician (RN) or master's level clinician (LCSW, LPC, LMHC, MFT) required.
5+ years of clinical experience required.
Will substitute 7 or more years of clinical experience along with an associate's degree and RN licensure in place of the bachelor's degree and RN licensure.
Experience working with total quality improvement or a behavioral healthcare background in treatment modalities, psychopharmacology, federal/state regulatory guidelines, performance measurement.
Ability to work independently with minimal supervision.
Project management skills and demonstrated experience.
General Job Information
Title:
Quality Clinical Reviewer - Remote
Grade:
25
Work Experience - Required:
Clinical
Work Experience - Preferred:
Quality
Education - Required:
A Combination of Education and Work Experience May Be Considered. - Nursing, Bachelor's - Nursing, Master's - Behavioral Health
Education - Preferred:
PsyD - Clinical Psychology
License and Certifications - Required:
LCSW, LMHC, LPC, MFT, PSY, RN - State and/or Compact State Licensure
Salary Range
Salary Minimum: $64,285
Salary Maximum: $102,855
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
About UsMagellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
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