…criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care +

…audits, continuing education, and the review of protocols and procedures + Review results of utilization and quality monitoring and participate in the

…as a MCO for Pharmacy Medicaid, such as bid, implementations, utilization management, quality, cost, reporting, regulatory and compliance initiatives. Experience in

…authorities for establishing best business practices. + Advise on the purchase and utilization of medical equipment and devices. + Review patient medical charts

…coordinated care delivery model. Coordinates] with the patient care team to review clinic [appointment availability] ( utilization ) [ ] to ensure that

…to develop education plans for the staff Monitors the allocation and utilization of personnel, based on continual changes in patient population/needs, and provides

…the clients' responses to the plan of care. + Performs a patient record review with the collaborating physician in a timely fashion but not less than every

…available guidance from an RN/HCP. Completed work requires only a general review by an RN/HCP for technical soundness, appropriateness and conformity to policy

…no more than 3-5 exceptions, as measured by random supervisory chart review and/or direct supervisory observation and co-worker feedback. Analyzes assessment data to

…in national user conferences to gain advanced knowledge of systems and customer utilization + Assists leads in developing clear and actionable product roadmaps for