Senior Clinical Reviewer, Registered Nurse
Albuquerque NM 87113
Conducts and oversees treatment record and case management record reviews. Trends and analyzes findings for internal and external reporting.
Essential Functionsbr>- 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.
- Responsible for auditing as well as validating internal audit results and/or corrective action plans.
Licenses, Certifications: Registered Nurse.
Education: BA/BS, Bachelor’s level RN.
Experience: 5-8 years; Job Specific: 5 yrs healthcare quality improvement
Computer Skills: Skills in word processing, spreadsheets, database management
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
General Job Information
TitleSenior Clinical Reviewer, Registered Nurse
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date4/30/2019
Date Requisition Created4/24/2019
EducationBachelors: Nursing (Required), Masters: Social Work (Required)
License and Certifications - RequiredLMSW - Licensed Master Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
- Master's level clinician.
- Experience with managed behavioral health and accreditation processes.
- Ability to quickly develop an alliance with providers via telephone.
- 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.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”