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- 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.
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Quality Clinical Reviewer - Boise, United States - Magellan Health Services
Description
Looking for candidates with:
Bachelors level clinician (RN) or Masters level clinician (LCSW, LPC, LMHC, MFT) or a provisional license.
- 3+ years of clinical experience
- Will substitute 5 or more years of clinical experience along with an Associates degree and RN licensure in place of the Bachelors 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.
Candidates must live within a reasonable commute to the Coeur d'Alene, Pocatello, Boise, Meridian, Eagle, Mountain Home, Caldwell and Nampa areas. This is a hybrid role.
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.Other Job Requirements
Responsibilities
Bachelors level clinician (RN) or Masters level clinician (LCSW, LPC, LMHC, MFT) required.3+ years of clinical experience required.
Will substitute 5 or more years of clinical experience along with an Associates degree and RN licensure in place of the Bachelors 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 ReviewerGrade
Work Experience - Required
ClinicalWork Experience - Preferred
QualityEducation - Required
A Combination of Education and Work Experience May Be Considered. - Nursing, Bachelor's - Nursing, Master's - Behavioral HealthEducation - Preferred
PsyD - Clinical PsychologyLicense and Certifications - Required
LCSW - Licensed Clinical Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, MFT - Marriage and Family Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtLicense and Certifications - Preferred
Salary Range
Salary Minimum:
$,Salary Maximum:
$,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.
Quality Clinical Reviewer professionals in Boise
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Ryan McDaniel
Project Manager
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trevor wilford
Data Scientist / System Architect