Clinical Reviewer III (ECSS), Remote in LA

Magellan Health; Baton Rouge (LA); Remote; USD 70,000 - 114,000; Full time

Job summary

A leading company is seeking a Clinical Reviewer III for a remote position in Louisiana. This role involves overseeing quality assurance for a statewide behavioral health initiative, requiring strong clinical knowledge and collaboration skills. Candidates must hold relevant licenses and have extensive experience in clinical settings, particularly in utilization management. The position offers a competitive salary and the opportunity to make a significant impact on early childhood mental health services.

Qualifications

• At least 7 years of clinical experience and 4 years in utilization management.

Responsibilities

• Review charts and analyze clinical record documentation.
• Conduct ongoing activities to monitor established quality of care standards.
• Prepare monthly performance reports.

Skills

Organization

Communication

Computer Skills

Education

Bachelor's in Nursing

Master's in Social Work

Job description

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.

Position Overview

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 tools.

Location and Requirements

This is a remote position based anywhere in Louisiana, requiring candidates to hold an active Louisiana license as an LPC, LCSW, or LMFT. Experience with ECSS, behavioral health or early childhood mental health, and prior experience in quality management, clinical auditing, or managed care is preferred.

Key Responsibilities

1. Review charts and analyze clinical record documentation.
2. Conduct ongoing activities to monitor established quality of care standards.
3. Collect, analyze, and prepare clinical record information for projects assessing the delivery of managed care services.
4. Prepare monthly performance reports.
5. Assist in planning and implementing activities to improve service delivery and quality of care, including developing and coordinating in-service education programs.
6. Provide training, interpretation, and support for QI Clinical Reviewer staff.
7. Audit and validate internal audit results and corrective action plans.

Other Job Requirements

Qualifications: RN/BSN or clinical credentials in a behavioral health field. If not an RN, must hold a Master's or Doctoral Degree and be a licensed behavioral health professional. Strong organization, communication, and computer skills are essential. Knowledge of utilization management procedures, Medicaid benefits, community resources, ICD and DSM coding, and experience in diverse patient care settings are preferred. Must have at least 7 years of clinical experience and 4 years in utilization management.

General Job Information

Title: Clinical Reviewer III (ECSS), Remote in LA

Grade: 26

Required Work Experience: Clinical, Utilization Management

Preferred Work Experience: [Specify if needed]

Required Education: Bachelor's in Nursing or Master's in Social Work

Preferred Education: [Specify if needed]

Required Licenses and Certifications: LCSW, LISW, LMFT, LMSW, LPCC, RN, or equivalent licensure in Louisiana

Preferred Licenses and Certifications: [Specify if needed]

Salary Range

Minimum: $70,715

Maximum: $113,145

This reflects the anticipated base salary range based on current data. Actual pay may vary based on individual skills, experience, and other factors. The position may be eligible for incentives and benefits to support wellbeing.

Magellan Health is an Equal Opportunity Employer and maintains a Tobacco-free workplace. All employees must adhere to security and compliance policies.