Review medical records to identify potential quality, safety, and utilization concerns

Conduct detailed case analysis and prepare clear, well-documented summaries and recommendations

Support peer review processes and quality improvement initiatives

Analyze trends and assist in identifying patterns in care delivery and outcomes

Collaborate with clinical leadership, including Medical Directors, to review findings

Participate in quality committees and performance improvement efforts

Ensure compliance with regulatory requirements and program standards

Coordinate with cross-functional teams such as case management, care coordination, and program integrity

Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW)

Minimum 3+ years of clinical e...