Responsibilities Primary Job Functions: Clinical: Chart Review and Documentation Conduct structured reviews of clinical records to assess service utilization, client engagement, and treatment plan compliance. Document all findings and coordination efforts in the electronic health record
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 cases.
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