Clinical Reviewer III (ECSS), Remote in LA

Santa Barbara Cottage Hospital; United States; Remote; USD 70,000 - 114,000; Full time

Job summary

A leading healthcare organization seeks a Clinical Reviewer III for its Early Childhood Supports and Services program. This remote position requires overseeing quality assurance activities, reviewing documentation for compliance, and supporting quality improvement initiatives. Candidates must hold a valid Louisiana license and possess extensive experience in clinical settings, particularly in utilization management.

Benefits

Health benefits

Life insurance

Other perks

Qualifications

• Minimum 7 years post-degree experience in clinical or behavioral health settings.
• Valid Louisiana license as LPC, LCSW, LMFT, LMSW, LPCC, or RN required.
• Experience in utilization management based on medical necessity criteria.

Responsibilities

• Review clinical and case management records for compliance and quality.
• Monitor quality standards within the provider network and clinical staff.
• Prepare monthly performance reports.

Skills

Organizational skills

Communication skills

Time management skills

Knowledge of ICD and DSM coding

Analytical skills

Education

Bachelor's in Nursing

Master's in Social Work

Tools

Computer systems proficiency

Job description

Job Description: Clinical Reviewer III (ECSS), Remote in LA

The Early Childhood Supports and Services (ECSS) program is a statewide behavioral health initiative funded by Louisiana Medicaid, supporting children from birth through age five and their families. It provides coordinated screening, assessment, referral, and care planning services to improve social-emotional and developmental outcomes, emphasizing early intervention, family engagement, and system-level collaboration.

The Clinical Reviewer will oversee quality assurance activities for the ECSS program, reviewing provider and care manager documentation for accuracy, quality, and compliance with applicable standards. The role requires advanced clinical knowledge, attention to regulatory standards, and collaboration skills. Additional quality activities include developing tools and supporting the ECSS Quality Improvement Program.

This is a remote position based in Louisiana, requiring candidates to hold an active Louisiana license as an LPC, LCSW, or LMFT. Preferred qualifications include experience with ECSS, behavioral health, early childhood mental health, and quality management.

Key Responsibilities

1. Review clinical and case management records for compliance and quality.
2. Monitor quality standards within the provider network and clinical staff.
3. Analyze clinical data for reports assessing service delivery effectiveness.
4. Prepare monthly performance reports.
5. Assist in planning and implementing service delivery improvements, including provider training.
6. Provide training and support to QA staff.
7. Audit and validate internal audit results and corrective actions.

Other Job Requirements

Qualifications:

• RN/BSN or equivalent clinical credentials; if not an RN, a Master’s or Doctoral degree in behavioral health with licensure.
• Strong organizational, communication, and time management skills.
• Knowledge of utilization management, Medicaid, community resources.
• Experience in diverse patient care settings, including inpatient care.
• Ability to work independently and in teams.
• Knowledge of ICD and DSM coding.
• Ability to analyze utilization issues and develop solutions.
• Proficiency with computer systems.
• Minimum 7 years post-degree experience in clinical or behavioral health settings.
• At least 4 years experience in utilization management based on 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:

Experience with ECSS, behavioral health, early childhood mental health, quality management.

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

Education - Preferred:

Additional relevant education or certifications.

License and Certifications - Required: Valid Louisiana license as LPC, LCSW, LMFT, LMSW, LPCC, or RN.

License and Certifications - Preferred: Relevant certifications as above.

Salary Range

Minimum: $70,715

Maximum: $113,145

This salary range is based on national data and may vary by location and individual qualifications. Benefits include health, life, and other perks. Magellan Health is an Equal Opportunity Employer and a Tobacco-Free Workplace.