The Director, Clinical Review serves as a key HMSA leader responsible for advancing consistent clinical review operations, strengthening accountability, improving turnaround times and documentation quality, supporting audit readiness, and partnering with Medical Directors, Clinical Operations, Health Services, Finance, Compliance, Quality, Provider Contracting, and delegated vendors to achieve measurable outcomes across the utilization management continuum. Provide strategic leadership, operational oversight, and continuous improvement of HMSA's Clinical Review functions within Utilization Management, including Prior Authorization functions, Prospective and Retrospective Review, Concurrent/Facility Review, and related clinical review activities across Commercial, Medicare Advantage, Dual Eligible Special Needs Plans (D-SNP), Federal Programs, and Medicaid (QUEST Integration).