Perform a variety of concurrent review of patient’s clinical information and retrospective utilization management reviews for efficiency Evaluate the patient’s situation against t…
Comprehensively review and evaluate appeal and grievance requests to identify and classify member and provider appeals. Determine eligibility, benefits, and prior activity related…
Takes direct responsbility for a team of healthcare agents Ensure the team is supported and enabled to perform at high standards and in accordance with the company's policies Pro…
Perform quality audits across all functions of utilization management operations, reviewing completed work in comparison to established documented procedures to determine accuracy.…
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