Magellan Health

100% REMOTE

Conducts reviews of clinical interactions and clinical documentation including reviews of case management records. Provides clinical reviews of CISC files to ensure clinical team is addressing all contractual needs of the program in the appropriate assessments. Provides feedback to the clinical teams on contractual compliance and quality of work within the case management system. Provider oversight of adherence to workflow requirements within the case management system.

• Audits and reviews case manager clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
• Conducts ongoing activities which monitor established quality standards for care managers.
• Collects, analyzes and prepares clinical record information for the purpose of assessing the efficiency, effectiveness and quality of the delivery of managed care services.
• Prepares monthly performance reports for the clinical team to support quality of work and contract adherence.
• Responsible for auditing assessment, files, care plans, and other clinical information in order to communicate and identify deficiencies.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements

Responsibilities

Bachelor's level clinician (RN) or master's level clinician (LCSW, LPC, LMHC, MFT) with 3+ years' experience required.

May consider RNs with an associate with 5+ years of clinical experience.

Experience working with total quality improvement or a behavioral healthcare background in treatment modalities, psychopharmacology, federal/state regulatory guidelines, performance measurement.

Ability to work independently with minimal supervision.

Project management skills and demonstrated experience.

General Job Information

Title

CISC Clinical Auditor

Grade

24

Work Experience - Required

Clinical

Work Experience - Preferred

Quality

Education - Required

A Combination of Education and Work Experience May Be Considered. - Nursing, Bachelor's - Nursing, Master's - Behavioral Health

Education - Preferred

PsyD - Clinical Psychology

License and Certifications - Required

LCSW - Licensed Clinical Social Worker - Care MgmtCare Mgmt, LMHC - Licensed Mental Health Counselor - Care MgmtCare Mgmt, LMSW - Licensed Master Social Worker - Care MgmtCare Mgmt, LPC - Licensed Professional Counselor - Care MgmtCare Mgmt, MFT - Marriage and Family Therapist - Care MgmtCare Mgmt, PSY - Psychologist - Care MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt

License and Certifications - Preferred

Salary Range

Salary Minimum:

$58,440

Salary Maximum:

$93,500

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.