- Conduct utilization reviews up to and including the appeal level.
- Screen charts, complete electronic worksheets, enter required information, and make level-one denial decisions when necessary.
- Conduct quality and clinical study data collection reviews, including chart reviews and detailed electronic data worksheets.
- Support Medical Review Analysts and Physician Consultants in the clinical review process.
- Provide administrative staff with training, problem-solving support, and procedural clarification.
- Provide technical assistance and conduct or participate in staff huddles.
- Participate in collaborative training specific to clinical study objectives.