Utilization Management & Case Review Specialist

The Utilization Management & Case Review Specialist is responsible for conducting utilization reviews, internal case record reviews, and quality assessments to support compliance, service quality, and positive outcomes. This position analyzes service utilization patterns, reviews documentation for accuracy and compliance, identifies trends and risk areas, and collaborates with internal teams and providers to promote continuous quality improvement.

The specialist serves as a key contributor in monitoring service effectiveness, ensuring contractual and regulatory compliance with case management paperwork, and supports improvement initiatives through data-informed recommendations and case review findings.