Quality Clinical Reviewer, Licensed/Remote in PA (Cambria Cty) - R00000064440

About the position

The Quality Clinical Reviewer is a remote position based in the Cambria County area of Pennsylvania, aimed at ensuring the quality of clinical interactions and documentation. The role involves conducting reviews of clinical records, analyzing data for quality improvement, and interacting with various stakeholders to enhance the delivery of managed care services. The position requires a master's level clinician with significant clinical experience to evaluate quality of care and patient safety risks.

Responsibilities
? Conduct reviews of clinical interactions and documentation including case management and provider treatment records.
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? Audit and review clinical documentation against regulations and accreditation standards.
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? Monitor established quality of care standards in the provider network and for care managers.
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? Evaluate Quality of Care and Critical/Adverse Incidents.
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? Assess patient safety risks and determine follow-up actions as per policies.
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? Collect, analyze, and prepare clinical record information for efficiency and quality assessments.
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? Prepare monthly performance reports and present findings at meetings as needed.
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? Assist in planning and implementing activities to improve service delivery and quality of care.
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? Develop and coordinate in-service education programs for providers and care managers.
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? Audit and validate internal audit results and corrective action plans.

Requirements
? Bachelor's level clinician (RN) or master's level clinician (LCSW, LPC, LMHC, MFT) required.
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? 5+ years of clinical experience required.
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? 7 or more years of clinical experience with an associate's degree and RN licensure may substitute for the bachelor's degree and RN licensure.
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? Experience in total quality improvement or behavioral healthcare background in treatment modalities and psychopharmacology.
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? Familiarity with federal/state regulatory guidelines and performance measurement.
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? Ability to work independently with minimal supervision.
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? Project management skills and demonstrated experience.

Nice-to-haves
? PsyD in Clinical Psychology preferred.

Benefits
? Comprehensive health benefits
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? Life insurance
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? Voluntary benefits
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? Short-term incentives
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? Employee wellness programs
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? Paid time off
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? Retirement savings plan options.

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