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Quality Clinical Reviewer - Hybrid/Remote Blair, Cty, PA

July 28, 2026

<div>Seeking PA licensed BH/RN candidates for this position supporting the Blair County area. Candidates need to reside near the Blair County area (Hollidaysburg, PA) and are flexible for any work onsite/offsite in the area. Conducts reviews of clinical interactions and clinical documentation including reviews of case management records and provider treatment records. 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.<ul><li>Audits and reviews case manager and provider clinical documentation and telephone interactions against regulations, accreditation standards and contract requirements. </li><li>Reviews provider treatment records against clinical and procedural established standards.</li><li>Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for care managers.</li><li>Conducts reviews of Quality of Care and Critical/Adverse Incidents.</li><li>Evaluates level of patient safety risk and need for follow-up actions per policies.</li><li>Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services. </li><li>Prepares monthly performance reports with assistance from Reporting and Analytics unit. Presents findings at provider and customer meetings as needed.</li><li>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.</li><li>Responsible for auditing as well as validating internal audit results and/or corrective action plans.</li></ul> The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. Other Job Requirements Responsibilities 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. General Job Information Title Quality Clinical Reviewer - Hybrid/Remote Blair, Cty, PA Grade 26 Work Experience - Required Clinical Work Experience - Preferred Quality Education - Required Bachelor's - Nursing, Master's - Behavioral Health Education - Preferred PsyD - Clinical Psychology License and Certifications - Required LCSW - Licensed Clinical Social Worker - Care MgmtCare MgmtCare Mgmt, LMHC - Licensed Mental Health Counselor - Care MgmtCare MgmtCare Mgmt, LPC - Licensed Professional Counselor - Care MgmtCare MgmtCare Mgmt, MFT - Marriage and Family Therapist - Care MgmtCare MgmtCare Mgmt, PSY - Psychologist - Care MgmtCare MgmtCare Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare MgmtCare 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. </div>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...