Essential Duties and Responsibilities: - Responsible for directing all quality operations including planning, implementation monitoring and reporting functions. - Develop and oversee an effective management system to continuously identify opportunities for improvement while maintaining adherence to
Essential Duties and Responsibilities: - Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments. - Provide written clinical rationales for CA Workers Compensation
Essential Duties and Responsibilities: - Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations. - Render medical necessity determinations for Medicare State East cases assigned. - Resolve all other technical issues within