Quality Clinical Reviewer

This is a fully remote position, open to applicants in Idaho.

📋 Description

• Perform evaluations of clinical interactions and documentation, which includes case management records and provider treatment documentation.

• Gather data following established protocols and analyze results for ongoing quality enhancement and both internal and external reporting.

• Engage with stakeholders from both internal and external sources.

• Conduct clinical assessments regarding Quality of Care and Critical/Adverse incidents related to clinical services.

• Review case manager and provider clinical documentation as well as telephone interactions for compliance with regulations, accreditation standards, and contractual obligations.

• Assess provider treatment records against established clinical and procedural benchmarks.

• Oversee quality-of-care standards within the participating provider network and among care managers.

• Assess patient safety risks and determine necessary follow-up actions in accordance with policies.

• Compile clinical record data for projects that evaluate the efficiency, effectiveness, and quality of managed care services.

• Generate monthly performance reports with support from the Reporting and Analytics unit.

• Share findings at provider and customer meetings as required.

• Aid in the planning and execution of service delivery and quality of care enhancement initiatives.

• Design and coordinate in-service education programs for providers and care managers.

• Audit and confirm the results of internal audits and corrective action plans.

⛳️ Requirements

• A bachelor's level clinician (RN) or a master's level clinician (LCSW, LPC, LMHC, MFT) is required.

• A minimum of 5 years of clinical experience is necessary.

• 7 or more years of clinical experience combined with an associate's degree and RN licensure may substitute for the bachelor's degree and RN license.

• Experience in total quality improvement or behavioral healthcare treatment approaches is preferred.

• Familiarity with psychopharmacology is essential.

• Understanding of federal and state regulatory guidelines is required.

• Experience in performance measurement is necessary.

• Ability to operate independently with minimal supervision is essential.

• Skills in project management along with proven experience are required.

• Required licenses/certifications include LCSW, LMHC, LPC, MFT, PSY, RN, and relevant state and/or compact-state licensure based on the clinician pathway.

• Must adhere to all applicable legal, regulatory, contractual, security, and internal policy requirements.

🏝️ Benefits

• Base salary range of $70,715-$113,145.

• Potential eligibility for short-term incentives.

• Comprehensive benefits package.

• Health, life, voluntary, and other benefits.

• Physical, mental, emotional, and financial wellbeing perks.

• Opportunities for professional growth and development.

• Focus on total health and wellness.

• Rewards and recognition programs.

• A sense of employee unity.

• A tobacco-free workplace.