Quality Clinical Reviewer, Licensed/Remote in PA (reputed company Cty)

Seeking Master's level clinician (RN/BH) in the reputed company County area of PA. This is a remote position in PA and candidates need to reputed company in/near the reputed company Cty area. 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 reputed company 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 reputed company 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 reputed company 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 reputed company of the bachelor's degree and RN licensure. Experience working with total quality improvement or a behavioral reputed company 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, Licensed/Remote in PA (reputed company Cty) 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 - 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 Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $64,285 Salary Maximum: $102,855 This information reflects the anticipated reputed company salary range for this position based on reputed company national data. Minimums and maximums may vary based reputed company. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company 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. reputed company, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their position; and reputed company with reputed company applicable legal, regulatory, and contractual requirements and internal policies and procedures. Apply Job!