Job Information
Magellan Health Services CISC Clinical Auditor in Albuquerque, New Mexico
100% REMOTE, Must be a resident of NM.
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.
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
25
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 Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, MFT - Marriage and Family Therapist - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Salary Range
Salary Minimum:
$64,285
Salary Maximum:
$102,855
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.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here (https://www.magellanhealth.com/media/760295/mg-federal-contractors-applicant-english.pdf) .
Warning: Employment Scam
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Please know that Magellan Health does not interview any candidate through email, nor do we issue checks to candidates to set up home offices. All of our available positions are posted on legitimate job boards and our recruitment team directly contacts candidates should there be a fit.
If you suspect you are being contacted by a false representative of Magellan Health, please call 410-953-2911