Quality Clinical Reviewer

Magellan Health

Quality Clinical Reviewer auditing clinical documentation and reviews to enhance quality of care in healthcare settings. Collaborates with stakeholders and prepares analytical reports for continuous improvement.

Posted 7/17/2026full-timeHollidaysburg • Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $70,715 - $113,145 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical review processes, quality improvement methodologies, and regulatory compliance within healthcare settings. Proficient in data analysis, stakeholder interaction, and project management to enhance service delivery and patient safety.

Highest-signal resume keywords

Clinical ReviewQuality ImprovementRegulatory ComplianceData AnalysisProject Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Documentation ReviewQuality of Care EvaluationPerformance MeasurementBehavioral Healthcare KnowledgePatient Safety Risk Assessment

Soft Skills

Independent WorkStakeholder InteractionPresentation Skills

Tools & Technologies

Reporting and Analytics Tools

Certifications & Qualifications

RN LicensureLCSWLPCLMHCMFT

Industry Keywords

Total Quality ImprovementAccreditation StandardsFederal/State Regulatory GuidelinesIn-Service Education ProgramsCorrective Action Plans

About the role

Key responsibilities & impact

Conducts reviews of clinical interactions and clinical documentation
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
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

Comprehensive benefits package
Health, life, and voluntary benefits
Short-term incentives