Collaborate cross-functionally with medical directors, providers, and care management teams on Part B and Part D drug utilization trends, denial/appeal processes, and exception requests; apply evidence-based criteria and Medicare coverage determinations to ensure appropriate utilization, support Stars/HEDIS quality measures, and drive value-based care initiatives such as biosimilar adoption and transitions from hospital outpatient to lower-cost infusion settings. Perform comprehensive utilization management reviews for Medicare Part B-covered medical drugs, including evaluation of medical necessity, alignment with FDA labeling and compendia-supported indications, prior authorization requests, step therapy protocols, and site-of-care optimization to support cost-effective, high-quality outcomes while minimizing total cost of care.