…mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years

…with TruCare Cloud or TruCare Classic platforms and have previous utilization review experience, **Position Purpose:** Supervises Prior Authorization, Concurrent

…each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. +

…specific clinical information for the purpose of completing initial and concurrent utilization review to ensure certification/approval of in-patient and post

…**Qualifications** + Outpatient behavioral health experience highly preferred + Managed care/ utilization review experience + Experience in a behavioral health

…to, overseeing the prior authorization process, growth hormone case management, utilization review reporting, pharmacy and therapeutics committee activities,

…optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge,

…for the comprehensive integration of Discharge Planning, Performance Improvement and Utilization Review activities at patient, hospital, and system levels.

…quality of care. **GENERAL SUMMARY AND PURPOSE:** Provides hospital case management/ utilization review and discharge planning collaboratively determining level

…selected utilization /cost and quality outcomes. + Participates in policy review , performs analysis and makes recommendations. + Participates in the retrospective