• Assists in development and maintenance of an efficient UM program to meet the needs of health plan members commensurate with company values. • Perform clinical reviews (i.e., part A, B, appeals, quality of care) and conduct peer to peer discussions. • Participate in inter-rater reliability activities. • Participate in analysis of utilization data and suggest improvement opportunities. • Provide appropriate mentoring and leadership to clinical teams as well as develop relationships to support growth and fiscal responsibility. • Participate in committees and workgroups to achieve department and corporate objectives. • Provide clinical support and participate in utilization management, quality management, clinical services and care management programs to identify opportunities for improvement and efficiency. • Serves as a clinical resource and subject matter expert to both clinical and non-clinical staff throughout the Devoted Health Plan. • Active participation in acute and post acute clinical rounds. • Conduct discussions with physicians in the Devoted network regarding: medical policies, utilization management, use of resources, and quality.