Quality Clinical Reviewer - (Onsite in Hollidaysburg, PA)

Conduct clinical reviews of case management records and provider treatment records for Blair County, auditing documentation and telephone interactions against regulations, accreditation standards, and contract requirements. Monitor quality of care in the provider network, evaluate patient safety risk, and review quality of care and critical/adverse incidents. Collect and analyze clinical record data to support continuous quality improvement, prepare monthly performance reports, and help coordinate provider and care manager education initiatives.