To insure compliance with all regulatory requirements, to implement, evaluate and improve as needed the Utilization Management Plan. This includes but is not limited to application of Milliman Care Guidelines to insure appropriate reimbursement/authorizations for a complex patient population; management of insurance denials; collection & analysis of utilization data; implementing strategic changes as indicated; to be a resource for the Care Management team on all utilization issues; responsible ...
AHA - 2 years ago
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