Quality Clinical Reviewer (Idaho) - Remote

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.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

• 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.

• Title Quality Clinical Reviewer (Idaho) - Remote
• Grade 26
• Work Experience
  - Required
• Clinical Work Experience
  - Preferred
• Quality Education
  - Required
• Bachelor's
  - Nursing, Master's
  - Behavioral Health
• Education
  - Preferred
• PsyD
  - Clinical Psychology
• License and Certifications
  - Required
• LCSW
  - Licensed Clinical Social Worker
• Care Mgmt Care Mgmt Care Mgmt, LMHC
  - Licensed Mental Health Counselor
  - Care Mgmt Care Mgmt Care Mgmt, LPC
  - Licensed Professional Counselor
  - Care Mgmt Care Mgmt Care Mgmt, MFT
  - Marriage and Family Therapist
  - Care Mgmt Care Mgmt Care Mgmt, PSY
  - Psychologist
  - Care Mgmt Care Mgmt Care Mgmt, RN
  - Registered Nurse, State and/or Compact State Licensure
  - Care Mgmt Care Mgmt Care Mgmt License and Certifications
  - Preferred
• Salary Range Salary Minimum: $70,715 Salary Maximum: $113,145 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.

Magellan 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…