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Utilization Management & Case Review Specialist at Home - Texas Family Care Network - ApplyBlast

Utilization Management & Case Review Specialist

Home - Texas Family Care Network

13 days ago

Dallas, Texas, United States

Onsite

Full Time

Medior

0 applicants

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About this role

The Utilization Management & Case Review Specialist conducts utilization reviews, internal case record reviews, and quality assessments to ensure compliance, service quality, and positive outcomes. This role involves analyzing service utilization patterns, reviewing documentation for accuracy, and collaborating with internal teams and providers to drive continuous quality improvement. The specialist supports monitoring service effectiveness, ensuring contractual and regulatory compliance, and contributes to improvement initiatives through data-informed recommendations.

Responsibilities

Conduct utilization reviews and internal case record audits to ensure regulatory compliance
Analyze service utilization patterns and identify trends to support quality improvement initiatives
Evaluate provider performance and develop corrective action recommendations based on review findings

Skills

Qualifications

Bachelor’s Degree in Healthcare Administration, Social Work, Human Services, Business Administration, Public Administration, Information Systems, or related fieldvalid Driver’s Licenseauto insuranceDPSDFPS