JOB SUMMARYThe Utilization Review Specialist provides subject matter expertise in performing utilization reviews and educates health plan staff and providers regarding the appropriate delivery of therapy services. Accountable for development of utilization management criteria and policy in conjunction with the health plan Medical Director and Health Services leadership.ESSENTIAL FUNCTIONS OF THE ROLEMakes accurate, clinically appropriate, and consistent approval authorization determinations, including collecting appropriate clinical information, applying appropriate medical criteria, consulting with Medical Director, and communicating authorization determinations to providers, members or patients in accordance with policy and p