Under the supervision of the Medical Director, the Quality Assurance and Utilization Management Director will be responsible for assuring the receipt of high quality, cost efficient medical outcomes for patients. Additionally:1. Develops and administers policies and procedures for utilization control of outpatient and outside referral services. Assists in the development and implementation of procedures to track and trend specialty and ancillary service utilization within the health centers. 2. Responsible for monitoring referral patterns and making recommendations to the Medical Director on strategies to contain costs, improve access and insure quality care; and ensures implementation of practice guidelines and referral criteria established by the Medical Director. 3. Responsible for the maintenance of good community relationships with providers who provide services to Clinicas patients and ensures a responsive system for authorization of services and payment of claims; and assisting in negotiating access to care in targeted areas, as requested. 4. Prepares statistical and narrative reports as requested by management on utilization patterns, expenditures by area and revenue stream, demographics of service delivery and trending of expenditures by program. 5. Establishes and amends, as necessary, a reporting system for contract providers; monitors and analyzes the use of services from outside providers. 6. Trains professional clinic staff on current standards of Utilization Management, medical/surgical diagnosis and treatment coding and reimbursement methodologies.