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
Essential Duties and Responsibilities: - Provides advanced clinical inquiry responses (verbal and written) to health-related inquiries from consumers, educators or medical/health professionals. - Provides medical subject matter expertise. - Performs advanced database searches. - Composes documents,
Essential Duties and Responsibilities: - Provides advanced clinical inquiry responses (verbal and written) to health-related inquiries from consumers, educators or medical/health professionals. - Provides medical subject matter expertise. - Performs advanced database searches. - Composes documents,
Essential Duties and Responsibilities: - Responsible for completing medical and/or behavioral health assessments within contract requirements - Conducts on-site, video call and/or telephonic assessments to determine an individuals needs for services and supports, eligibility, level of