Clinical Reviewer III (ECSS), Remote in LA

The Early Childhood Supports and Services (ECSS) program is a newly implemented, statewide behavioral health initiative funded by Louisiana Medicaid. ECSS supports children from birth through age five and their families by providing coordinated screening, assessment, referral, and care planning services aimed at improving social-emotional and developmental outcomes. The program prioritizes early intervention, family engagement, and system-level collaboration with other child-serving agencies. The Clinical Reviewer will support the implementation and ongoing oversight of quality assurance activities for the ECSS program. This position plays a key role in reviewing provider and care manager documentation for accuracy, quality, and compliance with state, federal, and contractual requirements. The role requires advanced clinical knowledge, attention to regulatory standards, and strong collaboration skills. Supports additional quality-related activities as needed to implement and sustain the ECSS Quality Improvement Program, including development of tool This is a remote position based anywhere in Louisiana, and requires candidates hold an active Louisiana license as an LPC, LCSW, or LMFT. Direct experience with ECSS, clinical experience in behavioral health or early childhood mental health, and prior experience in quality management, clinical auditing, or managed care is preferred. 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.

Other Job Requirements

Responsibilities

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. Also requires minimum of 4 years of experience conducting utilization management according to medical necessity criteria. General Job Information Title Clinical Reviewer III (ECSS), Remote in LA Grade 26 Work Experience - Required Clinical, Utilization Management Work Experience - Preferred Education - Required Bachelor's - Nursing, Master's - Social Work Education - Preferred License and Certifications - Required LCSW - Licensed Clinical Social Worker - Care Mgmt, LISW - Licensed Independent Social Worker - Care Mgmt, LMFT - Licensed Marital and Family Therapist - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred Salary Range Salary Minimum: $70,715 Salary Maximum: $113,145 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. Apply tot his job Apply To this Job