Essential Duties and Responsibilities: - Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. - Issue approvals, denials or recommendations based on contract
Essential Duties and Responsibilities: - Supervise the workforce management team and workflow to support management in all aspects of the workforce function within the project. - Create and maintain workforce monitoring schedules for team members to
Essential Duties and Responsibilities: - Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data. - Enter coded data into a system