Utilization Management Specialist

The Utilization Management Clinical Specialist will play an important role in SmarterDx’s next product launch in the Utilization Management and Case Management space. This role will work closely with Product and Data Science to design and refine strategies that help hospitals optimize resource use, ensure appropriate levels of care, and support timely and effective patient management. The specialist will bring a clinical and operational view to patient status determination, documentation workflows, and utilization review, contributing to AI tools that support care coordination and medical necessity compliance. Review and refine AI-generated determinations of medical necessity, level of care, and patient status, ensuring they align with guidelines. Collaborate with teams to define and validate rules that identify care transitions, avoidable delays, and under- or over-utilization. Support the design of clinical workflows that assist hospital case managers and physician advisors. Translate utilization review standards and discharge planning logic into product requirements that power automation and analytics tools. Serve as a subject matter expert for patient status, care coordination documentation, and payer-driven utilization review processes.