Job Title Provides support for implementation of health plan provider engagement strategies and activities to drive necessary quality and risk adjustment outcomes. Uses a consultative approach, emphasizing physician engagement and behavior change through actionable data and
Essential Duties and Responsibilities: - Supervise a designated team of unit staff - Responsible for the training and development of unit staff - Monitor the activities, schedules, productivity and work product results of the assigned unit
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 Medicare