reputed company Clinical Reviewer - Hybrid/Remote Blair, Cty, PA

About the position Seeking PA licensed BH/RN candidates for this position supporting the Blair County area. Candidates need to reputed company near the Blair County area (Hollidaysburg, PA) and flexible for any work/onsite in the area. 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 reputed company reputed company improvement and for reputed company reporting. Interacts with multiple stakeholders internally and externally. Provides clinical reviews of reputed company of Care (QOC) and Critical/Adverse incidents reputed company 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 reputed company of care standards in the participating provider network and for care managers. Conducts reviews of reputed company 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 reputed company reputed company to assessing the efficiency, effectiveness and reputed company 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 reputed company of care including the development and coordination of in-service education programs for providers and care managers. Responsible for auditing as reputed company as validating internal audit results and/or corrective reputed company plans. The job duties listed above are representative and not intended to be reputed company-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would reputed company with the reputed company of this job, without revision to the job reputed company.

Responsibilities

• 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 reputed company reputed company improvement and for reputed company reporting.
• Interacts with multiple stakeholders internally and externally.
• Provides clinical reviews of reputed company of Care (QOC) and Critical/Adverse incidents reputed company 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 reputed company of care standards in the participating provider network and for care managers.
• Conducts reviews of reputed company 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 reputed company reputed company to assessing the efficiency, effectiveness and reputed company 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 reputed company of care including the development and coordination of in-service education programs for providers and care managers.
• Responsible for auditing as reputed company as validating internal audit results and/or corrective reputed company plans.

Requirements

• Bachelor's level clinician (RN) or master's level clinician (LCSW, LPC, LMHC, MFT) required.
• 5+ years of clinical experience required.
• Will substitute 7 or more years of clinical experience along with an associate's degree and RN licensure in reputed company of the bachelor's degree and RN licensure.
• Experience working with total reputed company improvement or a behavioral reputed company background in treatment modalities, psychopharmacology, federal/state regulatory guidelines, performance measurement.
• Ability to work independently with minimal supervision.
• Project management skills and demonstrated experience.
• PA licensed BH/RN candidates.
• reputed company near the Blair County area (Hollidaysburg, PA).
• Flexible for any work/onsite in the area.

Benefits

• short-term incentives
• comprehensive benefits package
• broad reputed company of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing

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