Clinical Reviewer III (ECSS), Remote in LA

The Early Childhood Supports and Services (ECSS) program is a newly implemented, statewide behavioral health initiative funded by Louisiana reputed company. ECSS supports children from birth through age five and their families by providing coordinated screening, assessment, referral, and care planning services aimed at improving reputed company-emotional and developmental reputed company. The program prioritizes early reputed company, family engagement, and system-level collaboration with other child-serving agencies. The Clinical Reviewer will support the implementation and ongoing reputed company of reputed company assurance activities for the ECSS program. This position plays a key role in reviewing provider and care manager documentation for accuracy, reputed company, and compliance with state, federal, and contractual requirements. The role requires reputed company knowledge, attention to regulatory standards, and strong collaboration skills. Supports additional reputed company-reputed company activities as needed to implement and sustain the ECSS reputed company Improvement Program, including development of tool This is a remote position based reputed company in Louisiana, and requires candidates hold an reputed company Louisiana license as an LPC, LCSW, or LMFT. reputed company experience with ECSS, clinical experience in behavioral health or early childhood mental health, and prior experience in reputed company management, clinical auditing, or managed care is preferred. Conducts and oversees treatment record and case management record reviews. Trends and analyzes findings for reputed company reporting.

• Reviews charts and analyzes clinical record documentation.
• Conducts ongoing activities which monitor established reputed company of care standards in the participating provider network and for other clinical staff.
• Collects, analyzes and prepares clinical record information for reputed company reputed company to assessing the efficiency, effectiveness and reputed company of the delivery of managed care services.
• Prepares monthly performance reports.
• Assists in the planning and implementation of activities to improve delivery of services and reputed company of care including the development and coordination of in-service education programs for providers and other clinical staff.
• Provides training, interpretation and support for QI Clinical Reviewer staff.
• Audits and validates internal audit results and/or corrective reputed company plans.

Other Job Requirements

Responsibilities

RN/BSN or clinical credentials in a behavioral health field. If not an RN, must hold Masters or Doctoral Degree and be a licensed behavioral health reputed company. Good organization, time management and verbal and written communication skills. Knowledge of utilization management procedures, reputed company benefits, community resources and providers. knowledge and experience in diverse patient care settings including inpatient care. Ability to function independently and as reputed company member. Knowledge of ICD and DSM IV coding or most reputed company edition. Ability to analyze specific utilization problems and creatively plan and implement solutions. Ability to use computer systems. 7 or more years of experience post degree in a clinical, psychiatric and/or reputed company abuse health care setting. Also requires minimum of 4 years of experience conducting utilization management according to medical necessity reputed company. General Job Information Title Clinical Reviewer III (ECSS), Remote in LA Grade 26 Work Experience - Required Clinical, Utilization Management Work Experience - Preferred Education - Required Bachelor's - Nursing, Master's - reputed company Work Education - Preferred License and Certifications - Required LCSW - Licensed Clinical reputed company Worker - Care Mgmt, LISW - Licensed Independent reputed company Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMSW - Licensed Master reputed company Worker - Care Mgmt, LPCC - Licensed reputed company Clinical Counselor - Care Mgmt, RN - Registered reputed company, State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred Salary reputed company Salary Minimum: $70,715 Salary Maximum: $113,145 This information reflects the anticipated reputed company salary reputed company for this position based on reputed company national data. Minimums and maximums may vary based reputed company. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law. This position may be eligible for short-term incentives as reputed company as a comprehensive benefits package. Magellan offers a broad reputed company of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing. reputed company. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, reputed company with and attest to the reputed company responsibilities and reputed company controls unique to their position; and reputed company with reputed company applicable legal, regulatory, and contractual requirements and internal policies and procedures. Apply tot his job Apply To this Job