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Quality Clinical Reviewer - (Onsite in Hollidaysburg, PA)
Magellan Health Services
Opportunity Description
Seeking PA licensed BH/RN candidates for this position supporting Blair County. This position is working full time onsite at client location in Hollidaysburg, PA.
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 establishe...
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 establishe...
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