Utilization Management Director. One full-time employee. 4.2.11.1.6. 1. The Utilization Management Director shall: 4.2.11.1.6.1.1. Lead and develop the utilization management program and manage the medical review and authorization process. 4.2.11.1.6.1.2. Oversee the medical appropriateness and necessity of services provided to Members. 4.2.11.1.6. 1.3. Analyze and monitor utilization trends, identify problem areas and recommend action plans for resolution.
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Sources: Contract Modification, Contract Modification