Conducts and oversees treatment record and case management record reviews. Trends and analyzes findings for internal and external reporting.

• Reviews charts and analyzes clinical record documentation.


• Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff.


• 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.


• 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 other clinical staff.


• Provides training, interpretation and support for QI Clinical Reviewer staff.


• Audits and validates internal audit results and/or corrective action plans.

Responsibilities
Preferred Qualifications:
Master's level clinician.
Experience with managed behavioral health and accreditation processes.
Ability to quickly develop an alliance with providers via telephone., Required Qualifications:
Licensed Master's level social worker or Licensed Bachelor's level RN.
Experience in working with total quality improvement or behavioral healthcare background in treatment modalities, psychopharmacology, federal/state regulatory guidelines, performance measurement.
Ability to work independently with minimal supervision.
5 years' healthcare quality improvement experience.

General Job Information

Title
Clinical Reviewer

Grade
25

Work Experience - Required
Quality

Work Experience - Preferred

Education - Required
Bachelors - Nursing, Masters - Social Work

Education - Preferred

License and Certifications - Required
LCSW - Licensed Clinical Social Worker - Care Mgmt, LISW - Licensed Independent Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

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.