Clinical Reviewer III (ECSS), Remote in LA

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

Job summary

A leading healthcare company is seeking a Clinical Reviewer III for the ECSS program, focused on quality assurance in behavioral health. This remote role requires advanced clinical knowledge and collaboration skills, ensuring compliance with state and federal standards. The ideal candidate will have significant experience in clinical settings and utilization management.

Benefits

Comprehensive benefits package

Short-term incentives

Qualifications

• 7+ years experience in clinical, psychiatric, and/or substance abuse settings.
• Minimum of 4 years conducting utilization management.

Responsibilities

• Reviews provider documentation for accuracy and compliance.
• Conducts quality assurance activities for the ECSS program.
• Prepares monthly performance reports.

Skills

Organization

Time Management

Verbal Communication

Written Communication

Analysis

Education

Bachelor's - Nursing

Master's - Social Work

Job description

Clinical Reviewer III (ECSS), Remote in LA

Join to apply for the Clinical Reviewer III (ECSS), Remote in LA role at Magellan Health

Clinical Reviewer III (ECSS), Remote in LA

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Join to apply for the Clinical Reviewer III (ECSS), Remote in LA role at Magellan Health

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.
  
  

Responsibilities

Other Job Requirements

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.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Research, Analyst, and Information Technology

• Industries

  Hospitals and Health Care

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