Clinical Quality Reviewer

Medical ReviewerMedical ReviewerFull TimeRemoteSeniorTeam 201-500H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

43 days ago

Salary

$85K - $100K / year

Seniority

Senior

Postgraduate Degree5 yrs expEnglish

Job Description

• Review and coordinate resolution to complaints, grievances, appeals, incident reports, clinical reviews and investigations • Conduct Clinical Quality Reviews to ensure standards of care and quality standards are met • Collaborate with Clinical Excellence and Operations to develop quality standards • Act as an objective source of independent advice to ensure legitimacy, legality and goal achievement • Develop and maintain policies, procedures, plans, schedules, and job aids for quality processes and systems • Identify, plan, develop and execute performance improvement projects with the Quality Department and Programs leadership

Job Requirements

  • Master’s degree and a minimum of 5 years’ clinical experience in child and youth behavioral healthcare services
  • Licensure or Associate Status in Psychology, Marriage and Family Therapy, Counseling, School Psychology, Speech Therapy, Occupational Therapy, Social Work, or BCBA required
  • Minimum of 2 years of experience in healthcare quality assurance or similar work experience
  • Demonstrated proficiency in medical record analysis and chart review guidelines
  • Ability to apply healthcare data analysis to improve processes
  • Strong long-form narrative writing skills
  • Working knowledge of HIPAA privacy and security rules
  • Ability to communicate effectively verbally and in writing

Benefits

  • Health insurance
  • 401(k) matching
  • Flexible work hours
  • Paid time off

Related Categories

Related Job Pages

More Medical Reviewer Jobs

ContractRemote

Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York. Responsibilities include conducting comprehensive medical-legal reviews and appeals. Conduct reviews up to and including the app...

United States
Medical Reviewer43 days ago
Full TimeRemote

Are you looking for a position where you can utilize your experience processing retirement plan distributions and loans? Do you excel at attention to detail and catching oversights? Do you want the flexibility and convenience of working from home? Administrative Fiduciary Service...

United States
$60K - $65K / year
Part TimeRemoteTeam 501-1,000

As the Utilization Management (UM) Physician Reviewer, you will report to the Medical Director of UM and provide clinical expertise to ensure high-quality, medically necessary, and efficient patient care aligned with regulatory requirements. This role involves making direct decis...

United States
Part TimeRemote

The Registered Nurse (RN) plays a critical role as a physician extender within a remote healthcare team. In this position, the RN supports providers by efficiently managing Electronic Health Records (EHR), responding to patient inquiries, and delivering timely clinical guidance t...

United States