Utilization Review (UR) for Medical Treatments

The City of Austin is seeking a subcontractor to provide utilization review services for medical treatments, focusing on pre-authorization and concurrent review to verify medical necessity and compliance with established evidence-based guidelines including ODG and MTUS. This contract requires the vendor to evaluate treatment requests across a broad spectrum of care, ensuring alignment with recognized clinical standards to promote appropriate, cost-effective, and high-quality healthcare delivery. The review process must be rigorous, timely, and consistently applied to support informed decision-making and reduce unnecessary expenditures. The solicitation, posted on June 23, 2026, has a response deadline of July 23, 2026, and falls under NAICS code 621999 for other miscellaneous health care services. It is classified as a subcontract without a specific set-aside designation, and performance is expected to support the City’s healthcare operations in Texas. While no point of contact or physical location details are provided, the official solicitation can be accessed through the City’s finance portal. Vendors must demonstrate expertise in medical review protocols, familiarity with current clinical guidelines, and the ability to deliver accurate, defensible determinations under stringent regulatory and operational expectations.