Job Description
Job Description
Responsible for reviewing medical information to determine if requested treatment is medically necessary and appropriate according to the given standards.
Responsibilities
- Evaluation of Medical Information
- Analyzes medical information and applies established criterion to facilitate the utilization review process.
- Collaborates objectively with peer physicians to facilitate case resolution.
- Utilizes appropriate resources to perform utilization review process.
- Documents pertinent information in internal and external communications to support utilization management determinations and case resolutions.
- Adheres to the given standard operating procedures (SOP) and turnaround time to complete the review process.
- Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as ...