- Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services.
- Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information.
- Assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity.
- Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria.
·Caseload:25-30 reviews per day. This position is 98% telephonic.