reputed company Clinical Reviewer

This is a remote position in PA, must be licensed and reputed company in PA. 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 reputed company improvement and for reputed company reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of reputed company 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 reputed company of care standards in the participating provider network and for care managers. • Conducts reviews of reputed company 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 reputed company reputed company to assessing the efficiency, effectiveness and reputed company 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 reputed company of care including the development and coordination of in-service education programs for providers and care managers. • Responsible for auditing as reputed company as validating internal audit results and/or corrective reputed company plans. The job duties listed above are representative and not intended to be reputed company-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would reputed company with the reputed company of this job, without revision to the job reputed company. 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 reputed company 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 reputed company Clinical Reviewer Grade 26 Work Experience - Required Clinical Work Experience - Preferred reputed company Education - Required Bachelor's - Nursing, Master's - Behavioral Health Education - Preferred PsyD - Clinical Psychology License and Certifications - Required LCSW - Licensed Clinical reputed company Worker - Care MgmtCare MgmtCare Mgmt, LMHC - Licensed Mental Health Counselor - Care MgmtCare MgmtCare Mgmt, LPC - Licensed reputed company Counselor - Care MgmtCare MgmtCare Mgmt, MFT - Marriage and Family Therapist - Care MgmtCare MgmtCare Mgmt, PSY - Psychologist - Care MgmtCare MgmtCare Mgmt, RN - Registered reputed company, State and/or Compact State Licensure - Care MgmtCare MgmtCare Mgmt License and Certifications - Preferred Salary reputed company Salary Minimum: $70,715 Salary Maximum: $113,145 This information reflects the anticipated reputed company salary reputed company 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 reputed company as a comprehensive benefits package. Magellan offers a broad reputed company of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. reputed company. 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 reputed company, regulatory, and contractual requirements and internal policies and procedures. Apply tot his job Apply To this Job