Clinical Reviewer III
Brooklyn NY 11201 Brooklyn 3 15 MetroTech Center SWH
Job DescriptionConducts 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.
General Job Information
TitleClinical Reviewer III
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date9/11/2019
Date Requisition Created9/11/2019
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
- 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.
- Master's level clinician.
- Experience with managed behavioral health and accreditation processes.
- Ability to quickly develop an alliance with providers via telephone.
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.”