Performs Utilization Management (UM) reviews in accordance with U.S. State/Federal and other mandated regulations. Maintains compliance with regulatory changes affecting UM. Reviews UM requests for services against established clinical review criteria, referring cases not meeting criteria to a physician reviewer or prescribed escalation protocol. Releases UM determinations to claim stakeholders following client-established protocols. Maintains all required UM review documentation in the UM software in a timely manner. Serves as first level contact for customer concerns pertaining to UM reviews.