WORKING LEAD (REGULATORY): Coordinates workflow and determines priorities to assure highest quality of care with efficient utilization of available services; Schedules, assigns, oversees and reviews work; Establishes and maintains program protocols and procedures; Provides staff training and assistance; Conducts or assists in conducting performance evaluations; Acts as liaison with other operating units, agencies and outside officials regarding program policies and procedures; Prepares reports and correspondence; Assesses, evaluates and monitors documentation of all hospital disciplines when performing case reviews; Attends professional workshops, seminars and in-service training; May supervise Utilization Review Nurses and other staff engaged in review of medical records of individuals in state health care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs; May review medical records and compile documents for case presentations; May provide pre-certification for and coordination of inmates admitted to and discharged from acute care facilities; May lead an inspection team in IPR/UR and licensing review functions; May conduct entrance and exit interviews of care providers; May supervise and participate in hospital Medicare and Medicaid reimbursement programs including preparation of appeals on behalf of a facility relative to intermediate denials; May testify in court; May coordinate review and audit of occupational injury and/or disease disability cases for purpose of determining medical management, cost containment, peer review and rehabilitation; May notify acute care hospitals of scheduled utilization review including conducting second level review of cases and case referral to a physician consultant for final disposition; Performs related duties as required. ADVANCED WORKING LEVEL (INVESTIGATORY): Conducts complex investigations into allegations of abuse or neglect of individuals with an intellectual disability; Conducts complex investigations into cases where a death has resulted of an individual with an intellectual disability for whom the Department of Developmental Services has direct or oversight responsibility for medical care; Reviews medical care that was provided to individuals; Assists in the investigation to determine if the death is a result of abuse or neglect; Participates in the reviews of events, overall care, quality of life and medical care preceding a death; Works cooperatively with State and local police, States Attorneys and other protective services organizations; Interviews alleged victims, direct care providers, families and other potential witnesses; Prepares comprehensive, complex investigative reports; Maintains records and documentation; Reviews medical records for pertinent information related to investigations; May provide information and assistance to the Independent Mortality Review Board or Fatality Review Board for Persons with Disabilities; May testify in court proceeding; Performs related duties as required.