Clinical Quality & Utilization Review Specialist

Supervising the Director of Utilization Management, this specialist manages dual roles in utilizing management and peer review to assess medical appropriateness and quality across inpatient and outpatient settings. The role involves coordinating peer review activities, facilitating Root Cause Analyses, and partnering with interdisciplinary teams to support evidence-based decision-making and drive continuous improvement. Serving as a key liaison among providers, compliance, nursing, and leadership, the specialist ensures that findings from reviews translate into sustainable improvements in clinical practice.