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Quality Clinical Reviewer
Magellan Health - Boise, ID
posted 2 months ago
About the position
The Quality Clinical Reviewer is responsible for conducting reviews of clinical interactions and documentation to ensure compliance with established quality of care standards. This role involves analyzing clinical records, preparing performance reports, and interacting with various stakeholders to promote continuous quality improvement in behavioral healthcare services. The position requires a clinician with significant experience in clinical practice and quality improvement methodologies, working independently in a hybrid environment.
Responsibilities
- Conduct reviews of clinical interactions and clinical documentation including case management records and provider treatment records.
- Collect data following established procedures and analyze findings for continuous quality improvement and reporting.
- Interact with multiple stakeholders internally and externally regarding quality of care.
- Audit and review case manager and provider clinical documentation against regulations and standards.
- Evaluate patient safety risks and determine follow-up actions as per policies.
- Prepare monthly performance reports and present findings at provider and customer meetings.
- Assist in planning and implementing activities to improve service delivery and quality of care.
- Develop and coordinate in-service education programs for providers and care managers.
- Validate internal audit results and corrective action plans.
Requirements
- 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 in total quality improvement or behavioral healthcare background in treatment modalities and psychopharmacology.
- Ability to work independently with minimal supervision.
- Project management skills and demonstrated experience.
Nice-to-haves
- PsyD in Clinical Psychology preferred.
Benefits
- Comprehensive health benefits
- Life insurance
- Voluntary benefits
- Short-term incentives
- Employee wellness programs
