Quality Clinical Reviewer

3 weeks ago

Boise, Idaho, United States Magellan Health Full time

Looking for candidates with:

- Bachelors level clinician (RN) or Masters level clinician (LCSW, LPC, LMHC, MFT) or a provisional license.
- 3+ years of clinical experience
- Will substitute 5 or more years of clinical experience along with an Associates degree and RN licensure in place of the Bachelors degree and RN licensure.
- Experience working with total quality improvement or a behavioral 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.

Candidates must live within a reasonable commute to the Coeur d'Alene, Pocatello, Boise, Meridian, Eagle, Mountain Home, Caldwell and Nampa areas. This is a hybrid role.

Conducts reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records. Collects data following established procedures and analyzes findings for purposes of continuous quality improvement and for internal and external reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services.
  • Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
  • Reviews provider treatment records against clinical and procedural established standards.
  • Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.
  • Conducts reviews of Quality of Care and Critical/Adverse Incidents.
  • Evaluates level of patient safety risk and need for follow-up actions per policies.
  • 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 provider and customer meetings as needed.
  • 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.

Other Job Requirements

Responsibilities

Bachelors level clinician (RN) or Masters level clinician (LCSW, LPC, LMHC, MFT) required.
3+ years of clinical experience required.
Will substitute 5 or more years of clinical experience along with an Associates degree and RN licensure in place of the Bachelors degree and RN licensure.
Experience working with total quality improvement or a behavioral 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.

General Job Information

Title

Quality Clinical Reviewer

Grade

25

Work Experience - Required

Clinical

Work Experience - Preferred

Quality

Education - Required

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

Education - Preferred

PsyD - Clinical Psychology

License and Certifications - Required

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

License and Certifications - Preferred

Salary Range

Salary Minimum:

$64,285

Salary Maximum:

$102,855

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.

  • Clinical Quality Improvement

    1 week ago

    Boise, Idaho, United States St. Luke's Health System Full time

    OverviewAt St. Luke's, our dedicated team of RNs strive to build a positive, supportive, and inclusive culture that delivers exceptional patient experiences.As a Clinical Quality Improvement RN, you will be the compliance "guru" for our Home Health team in the Treasure Valley. You will conduct chart reviews to ensure compliance with standards/regulations and...

  • Clinical Lab Scientist

    4 weeks ago

    Boise, Idaho, United States tapwage Full time

    Employment Type:Part timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.We are seeking a 20...

  • Clinical Lab Scientist

    3 weeks ago

    Boise, Idaho, United States tapwage Full time

    Employment Type:Part timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.We are seeking a 20...

  • Quality Systems Associate

    3 weeks ago

    Boise, Idaho, United States GRIFOLS, S.A. Full time

    Would you like to join an international team working to improve the future of healthcare? Do you want to enhance the lives of millions of people? Grifols is a global healthcare company that since 1909 has been working to improve the health and well-being of people around the world. We are leaders in plasma-derived medicines and transfusion medicine and...

  • Quality Systems Associate

    4 weeks ago

    Boise, Idaho, United States GRIFOLS, S.A. Full time

    Would you like to join an international team working to improve the future of healthcare? Do you want to enhance the lives of millions of people? Grifols is a global healthcare company that since 1909 has been working to improve the health and well-being of people around the world. We are leaders in plasma-derived medicines and transfusion medicine and...

  • Quality Control Supervisor

    7 days ago

    Boise, Idaho, United States Patrick Allen Group Full time

    Company Description Patrick Allen Group is a technical placement recruiting agency that provides high-quality candidate sourcing services for the engineering, IT, manufacturing, and financial disciplines. We deploy customized, creative, focused candidate searches and uses today's technology to find top talent. Patrick Allen Group is committed to providing...

  • Clinical Documentation Specialist-RN

    1 week ago

    Boise, Idaho, United States St. Luke's Health System Full time

    OverviewOur patients represent diverse backgrounds, and so do we We cultivate a workplace atmosphere that celebrates the distinct strengths, backgrounds, and perspectives of our employees. This philosophy is integral to our exceptional patient-centered care. Through fostering a positive, supportive, and inclusive culture, we aim to provide outstanding...

  • Clinical Resource Manager PRN Days

    3 weeks ago

    Boise, Idaho, United States Trinity Health Full time

    Employment Type:Full timeShift:Day ShiftDescription: SummaryAt Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of...

  • Infectious Disease Clinical Pharmacy Specialist

    2 months ago

    Boise, Idaho, United States St. Luke's Health System Full time

    St. Luke's Health System in Boise, Idaho is seeking an Infectious Disease Clinical Pharmacy Specialist – Outpatient Antimicrobial TherapyThis clinic pharmacist will be implementing a new practice as an outpatient parenteral antimicrobial therapy (OPAT) pharmacist in collaboration with our infectious diseases and antimicrobial stewardship teams. Ambulatory...

  • Infectious Disease Clinical Pharmacy Specialist

    3 weeks ago

    Boise, Idaho, United States St. Luke's Health System Full time

    St. Luke's Health System in Boise, Idaho is seeking an Infectious Disease Clinical Pharmacy Specialist – Outpatient Antimicrobial TherapyThis clinic pharmacist will be implementing a new practice as an outpatient parenteral antimicrobial therapy (OPAT) pharmacist in collaboration with our infectious diseases and antimicrobial stewardship teams. Ambulatory...

  • Manager of Clinical Operations

    1 week ago

    Boise, Idaho, United States Vatica Health Full time

    The Manager of Clinical Operations leads and manages the Clinical Operations teams in multiple Metropolitan Service Areas (MSAs) to ensure their efficiency, productivity, and effectiveness. The Manager of Clinical Operations collaborates with and reports to the Senior Director of Clinical Operations on clinical and non-clinical issues (employee relations,...

  • MA Boise OB/GYN Clinic Part-Time Days

    2 months ago

    Boise, Idaho, United States Trinity Health Full time

    Employment Type:Part timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.TheBoise OB/GYN...

  • Sourcing Manager 3-IHT Non-Clinical

    1 week ago

    Boise, Idaho, United States St. Luke's Health System Full time

    Overview: At St. Lukes, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a...

  • MA Boise Pediatrics Clinic Full-Time Days

    2 months ago

    Boise, Idaho, United States Trinity Health Full time

    Employment Type:Full timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.The Boise Pediatrics...

  • President, Saint Alphonsus Health Alliance, Clinical Integrated Network

    3 weeks ago

    Boise, Idaho, United States Trinity Health Full time

    Employment Type:Full timeShift:Day ShiftDescription:TRINITY HEALTHPresident, Saint Alphonsus Health Alliance, Clinically Integrated NetworkPOSITION PURPOSE Under the general direction of the Saint Alphonsus Health System (SAHS) CEO and A-2 relationship with the Trinity Health SVP of Clinical Integration and Physician Services, provides leadership and...

  • President, Saint Alphonsus Health Alliance, Clinical Integrated Network

    2 months ago

    Boise, Idaho, United States Trinity Health Full time

    Employment Type:Full timeShift:Day ShiftDescription:TRINITY HEALTHPresident, Saint Alphonsus Health Alliance, Clinically Integrated NetworkPOSITION PURPOSE Under the general direction of the Saint Alphonsus Health System (SAHS) CEO and A-2 relationship with the Trinity Health SVP of Clinical Integration and Physician Services, provides leadership and...

  • Medical Director DMEPOS

    1 week ago

    Boise, Idaho, United States Optum Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...

  • MA Clinic Locations in Boise/Meridian/Eagle Full-Time Days

    2 months ago

    Boise, Idaho, United States Trinity Health Full time

    Employment Type:Full timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.The Saint Alphonsus...

  • MA Clinic Locations in Boise/Meridian/Eagle Full-Time Days

    3 weeks ago

    Boise, Idaho, United States Trinity Health Full time

    Employment Type:Full timeShift:Day ShiftDescription:At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.The Saint Alphonsus...

  • RN Clinical Supervisor Med Surg Dept

    1 week ago

    Boise, Idaho, United States Mercy Full time

    We are offering a Sign-On Bonus of up to $20,000 based on experience and shift selection! The Clinical Supervisor plays a crucial role in ensuring the delivery of safe, high-quality, and cost-effective care by competent colleagues. They are responsible for optimizing resource utilization to meet productivity and financial objectives. Collaborate...