Clinical Utilization Management & Analytics Specialist

Requisition : req
1456

Employment Type: Unclassified Regular Full-Time (URF)

Division: Health Contracts

Compensation:  - , Annual Salary

Job Closing: 10/30/2026 11:59PM CT

Location: TRS Headquarters Building 2
1900 Aldrich Street
Austin, Texas, 78723
United States

With the Health Division, you’ll be joining a passionate team of self‑motivated change agents united by our mission: driving to design the delivery of high‑quality healthcare for nearly three‑quarters of a million active and retired Texas public educators. The healthcare industry is complex and we’re a team of problem‑solvers who are up for the challenge. With a focus on innovation and collaboration to catalyze the market, we spend nearly $4 billion annually on healthcare to make a difference in our members’ lives.

With a career at TRS, you’ll be empowered through a culture of continuous learning, front‑line decision‑making, coaching and mentorship to shape the future of our work, while transforming healthcare delivery for 1 in 41 Texans.

• Monitors and improves the health plan administrator’s utilization management operations, including prior authorization, concurrent and retrospective review, case management, appeals, and transitions of care.
• Designs custom utilization management requirements, clinical protocols, and performance expectations, and assesses adherence to established criteria and industry standards.
• Evaluates vendor performance and recommends actions to reduce waste, improve affordability and outcomes, and preserve access to medically necessary care.
• Serves as a primary clinical and analytic resource for utilization management contract oversight, including prior authorization, medical necessity criteria, peer‑to‑peer review, site‑of‑care optimization, exception management, and escalated clinical issues.

• Collaborates with TRS leadership, consultants, and health plan administrators to design and implement custom utilization management requirements and clinical programs.
• Collaborates with health plan administrators to operationalize approved utilization management changes and ensure consistent implementation.
• Evaluates proposed utilization management policies, clinical criteria, and program enhancements for alignment with TRS objectives.
• Develops evidence‑based initiatives that reduce unnecessary high‑cost care and promote appropriate lower‑cost settings and less‑invasive, high‑quality alternatives.
• Assists with developing contract requirements, performance standards, and clinical program specifications during procurements and contract amendments.
• Coordinates implementation activities related to new utilization management initiatives, clinical programs, and regulatory changes.

• Analyzes utilization management, prior authorization, site‑of‑care, claims, outcomes, and provider data to identify cost drivers, avoidable utilization, low‑value care, variation, clinically appropriate alternatives, and opportunities to improve quality and total cost of care.
• Evaluates proposed programs for their effects on quality, access, site‑of‑care, member experience, and total cost.
• Develops reports, dashboards, business cases, and recommendations that quantify opportunities and measure cost, utilization, quality, and outcomes.
• Provides clinical expertise for policy development, vendor management activities, audits, procurements, and special projects.

Performs related work as assigned.

• Bachelor’s degree in nursing, medicine, pharmacy, healthcare administration, health informatics, data analytics, public health, or a closely…