utilization review, and collaboration with RN Case and disease managers. This director position will report to the Sr. Medical... Director, Medical Management. Responsibilities: Your Work In this role, you will: Provide medical decision-making...
of billed physician services and related outpatient facility services against FEP medical benefit and/or payment policy. The... claims and medical records review of services rendered to FEP members. Post-Service Clinical Nurse reviews for medical...