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Seeking candidates with RN//or behavioral health license in the State of New Mexico and Psychiatric/Behavioral Health experience preferred. This is a remote position.

Applies clinical expertise in conducting standardized independent reviews of case management and provider documentation and treatment records. Conducts reviews of Quality of Care and Critical/Adverse Incidents following policies to identify patient safety risks and coordinates follow-up actions. Prepares reports for quality purposes based on findings and monitors follow-up actions and recommendations for improvement. Trends and analyzes findings for internal and external reporting. Interfaces with providers and customers. Interacts with multiple stakeholders internally and externally.

+ Reviews charts and analyzes clinical record documentation against state, federal and accreditation standards and contract requirements using standard tools and reporting mechanisms.

+ Reviews Quality of Care and Critical/Adverse incidents to assess risk and patient safety issues based on policy and procedural guidelines.

+ Conducts ongoing activities which monitor established quality of care standards in the provider network and for care managers.

+ 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 with assistance from Reporting and Analytics unit. Presents findings at management, provider, customer and quality meetings.

+ 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 care managers.

+ Responsible for auditing as well as validating internal audit results and/or corrective action plans.

+ Trains, precepts, coaches, and mentors Quality Clinical Reviewers.

+ Leads and contributes to Quality activities, such as quality improvement activities, external audits, annual quality reporting, and accreditation requirements.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements

Responsibilities

Bachelor's level clinician (RN) or master's level clinician (LCSW, LPC, LMHC, MFT) required.

May consider an RN with an associate's degree with two additional years of clinical experience (9 total).

Experience working with total quality improvement with a healthcare background in treatment modalities, psychopharmacology, federal/state regulatory guidelines, performance measurement.

Ability to work independently with minimal supervision.

Project management skills and demonstrated experience.

Strong interpersonal and organizational skills.

General Job Information

Title

Senior Quality Clinical Reviewer - BH - Remote, NM

Grade

26

Work Experience - Required

Clinical

Work Experience - Preferred

Quality

Education - Required

A Combination of Education and Work Experience May Be Considered., Bachelor's - Nursing, Master's - Behavioral Health

Education - Preferred

License and Certifications - Required

LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, LMHC - Licensed Mental Health Counselor - Care MgmtCare Mgmt, LPC - Licensed Professional Counselor - Care MgmtCare Mgmt, MFT - Marriage and Family Therapist - Care MgmtCare Mgmt, PSY - Psychologist - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt

License and Certifications - Preferred

Salary Range

Salary Minimum:

$70,715

Salary Maximum:

$113,145

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

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.