Quality Clinical Reviewer

Magellan Health

Quality Clinical Reviewer conducting clinical reviews and documentation analysis for managed care services. Interacting with stakeholders and ensuring quality of care standards are met.

Posted 7/14/2026full-timeBlair • Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $70,715 - $113,145 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical documentation review, quality of care evaluation, and data analysis to enhance managed care services. Proficient in project management and stakeholder interaction to drive continuous quality improvement initiatives.

Highest-signal resume keywords

Clinical Documentation ReviewQuality Of Care EvaluationData AnalysisProject ManagementRegulatory Compliance

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical ExperienceTotal Quality ImprovementBehavioral Healthcare BackgroundPerformance MeasurementPsychopharmacology

Soft Skills

Independent WorkStakeholder Interaction

Tools & Technologies

Reporting And Analytics

Certifications & Qualifications

RN LicensureLCSWLPCLMHCMFT

Industry Keywords

Clinical InteractionsCase ManagementAccreditation StandardsPatient Safety RiskIn-Service Education Programs

About the role

Key responsibilities & impact

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 continuous quality improvement and for internal and external reporting.
Interacts with multiple stakeholders internally and externally.
Provides clinical reviews of Quality of Care (QOC) and Critical/Adverse incidents related to clinical services.
Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements.
Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.
Evaluates level of patient safety risk and need for follow-up actions per policies.
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 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 quality of care including the development and coordination of in-service education programs for providers and care managers.
Responsible for auditing as well as validating internal audit results and/or corrective action plans.

Requirements

What you’ll need

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 place of the bachelor's degree and RN licensure.
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.

Benefits

Comp & perks

health insurance
life insurance
retirement plans
flexible work arrangements
professional development opportunities