…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

…collaboration with other directors, determines, monitors and ensures that productivity and utilization goals are met + Maintains quality patient care and service by

…their journey to health and wellness. Essential functions include: + Clinical review , entry and modification of heme/TCT treatment plans. + Oncology order

…plan, including transfer eligibility, level of care, resource prioritization & utilization , timely acceptance, and appropriate priority and mode of transport. +

…Medicaid grievance and appeals rights. + Determines member eligibility and utilization history using various Molina systems and databases (eg, membership, claims,

…professional training needs and opportunities for staff. Conducts an on-going review of program functioning, and evaluates treatment effectiveness. Ensures that

…for direct oversight and the day to day management of clinical appeals review processes within Appeals & Grievances Department. + Manages the intake, investigation

…+ Verifies scheduling data is correct through reports, schedule and chart review . + Utilizes the chart preparation flow sheet to communicate any discrepancies

…of specialty practice.** **5. Participates in APRN interviewing, credentialing, and peer review process as requested.** **6. Participates in a minimum of one

…unit specific and organizational wide budget constraints as evidenced by appropriate utilization of all resources. + Prioritizes workload and reflects flexibility in