Senior Clinical Reviewer, Registered Nurse

Albuquerque NM 87113

Job Description

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

Essential Functions

br>- 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.

QUALIFICATIONS

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

Title

Senior Clinical Reviewer, Registered Nurse

Grade

24

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

4/30/2019

Date Requisition Created

4/24/2019

Minimum Qualifications

Education

Bachelors: Nursing (Required), Masters: Social Work (Required)

License and Certifications - Required

LMSW - Licensed Master Social Worker - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 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.”