• Assures the highest standards of clinical quality and regulatory compliance across Utilization Management department activities for all government lines of business and delegated vendors. • Confirms Utilization Management’s compliance with federal, state, and regulatory guidelines (e.g., NCQA, CMS). • Assists with policies and procedures, and continually monitoring regulatory changes. • Collects, analyzes, and interprets clinical data, clinical outcomes, and performance metrics to prepare comprehensive reports and audit responses. • Collaborates across departments to resolve issues and provide education on regulatory requirements and best practices.