Quality Clinical Reviewer - Somerset, PA
Quality Clinical Reviewer - Somerset, PA
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1 Vacancy
Job Description
ATTENTION MILITARY AFFILIATED JOB SEEKERS- Our organization works with partner companies to source qualified talent for their open roles. The following position is available toVeterans Transitioning Military National Guard and Reserve Members Military Spouses Wounded Warriors and their Caregivers. If you have the required skill set education requirements and experience please click the submit button and follow the next steps. Unless specifically stated otherwise this role is On-Site at the location detailed in the job post.
Seeking PA licensed candidates for this remote position supporting the Bedford / Somerset County area candidates need to reside in the PA 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 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.
Additional Qualifications/Responsibilities
Other Job Requirements
Responsibilities
Bachelors level clinician (RN) or masters 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 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 Reviewer - Somerset-Bedford PA
Grade
25
Work Experience - Required
Clinical
Work Experience - Preferred
Quality
Education - Required
A Combination of Education and Work Experience May Be Considered. - Nursing Bachelors - Nursing Masters - 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:
$64285
Salary Maximum:
$102855
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 individuals 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.
Employment Type
Full Time
