Quality Clinical Reviewer (Idaho) - Remote

Magellan Health Services
Boise
Workplace: RemoteFull timeUSD 70,715 - 113,145 annuallyFunction: Quality & Regulatory (Non-Software)Experience: 5+ yearsSkills: ["Continuous quality improvement","Independent work","Project management","Data analysis","Stakeholder management"]

Review clinical interactions and documentation, including case management and provider treatment records, to assess Quality of Care and monitor critical/adverse incidents. Audit and validate clinical documentation and interactions against regulations, accreditation standards, and contract requirements. Collect and analyze clinical-record data for continuous quality improvement and reporting, prepare monthly performance reports, and support provider and care-manager education and corrective actions.

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Magellan Health Services
Magellan Health Services
1 week ago

Quality Clinical Reviewer (Idaho) - Remote

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Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 9 hours agoStatus: Live

Job Summary

Review clinical interactions and documentation, including case management and provider treatment records, to assess Quality of Care and monitor critical/adverse incidents. Audit and validate clinical documentation and interactions against regulations, accreditation standards, and contract requirements. Collect and analyze clinical-record data for continuous quality improvement and reporting, prepare monthly performance reports, and support provider and care-manager education and corrective actions.
Location: Boise
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Conduct reviews of clinical interactions and documentation, including case management and provider treatment records, for Quality of Care and critical/adverse incidents.
  • •Audit and validate case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards, and contract requirements.
  • •Evaluate patient safety risk and determine follow-up actions per policies.
  • •Collect, analyze, and prepare clinical record information for projects assessing efficiency, effectiveness, and quality of managed care service delivery.
  • •Prepare monthly performance reports and support planning activities to improve service quality, including provider and care-manager in-service education and corrective actions.

Pay and Benefits

Salary: USD 70,715 - 113,145 annually
Perks:Health InsuranceLife Insurance

Key Requirements

  • •Bachelor's-level clinician (RN) or master's-level clinician (LCSW, LPC, LMHC, MFT) required.
  • •5+ years of clinical experience required; 7+ years with associate’s degree and RN licensure may substitute for the bachelor’s requirement.
  • •Experience with total quality improvement or behavioral healthcare treatment modalities, including psychopharmacology, regulatory guidelines, and performance measurement.
  • •Ability to work independently with minimal supervision.
  • •Project management skills and demonstrated experience.
Experience:5+ yearsBehavioral healthcare
Education:
Skills:Continuous quality improvementIndependent workProject managementData analysisStakeholder management
Licenses:LCSWLMHCLPCMFTPSYRN

Company Brief

Magellan Health Services
Provides managed behavioral health, specialty healthcare, pharmacy management, and population health services to health plans, employers, and government agencies, focusing on improving outcomes and reducing costs through integrated care solutions.
Industry: HealthTech
Company Size: Enterprise (1,001+ employees)
Growth: Established Company
Funding: IPO / Publicly Listed
Headquarters: Scottsdale, United States
Founded: 1969
WebsiteLinkedIn