Conducts and oversees treatment record and case management record reviews. Trends and analyzes findings for internal and external reporting. Reviews charts and analyzes clinical record documentation. Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality 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 quality 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 action plans. Requires 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 professional. Good organization, time management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. Knowledge and experience in diverse patient care settings including inpatient care. Ability to function independently and as a team member. Knowledge of ICD and DSM IV coding or most current 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 substance abuse health care setting. Minimum of 4 years of experience conducting utilization management according to medical necessity criteria.
By applying, you consent to your information being transmitted by Jooble to the Employer, as data controller, through the Employer’s data processor SonicJobs.
See Sonicjobs Privacy Policy at and Terms & Conditions at and SonicJobs Privacy Policy at and Terms of Use at
...Part-time - Commercial Janitor Job - Fort Myers Schedule: 7 days a week (starting at 6:45am). Salary: $800 per month. Payment:... ...and proactive cleaning professional to join our crew to provide morning service for a store in Fort Myers. As our commercial cleaner...
...Amare Medical Network is seeking a travel nurse RN OR - Operating Room for a travel nursing job in San Francisco, California. Job... ...Room Nurses may be employed in several roles including scrub, circulating or function in both roles. Amare Medical Network Job ID #335...
Lake Region High School Full-time/year-round position 40 hours per week Monday - Friday 7:00 a.m. - 3:30 p.m.
...Job Description Nightingale Nurses is seeking a travel Nuclear Medicine Technologist for a travel job in Salem, Oregon. Job Description & Requirements ~ Specialty: Nuclear Medicine Technologist ~ Discipline: Allied Health Professional ~ Start Date: 08/18/...
...81; How We Recognize and Reward Success: &##128663; Win Big with world-class contests including prizes like brand-new Jeeps, Lululemon gear, and more &##127757; Retreats to Stunning Locations like Iceland, Cabo, and Cancun &##128218; Twice-Weekly Training Sessions...