* Clinical leadership within Optum Serve and reports to the Chief Medical Officer, Community Care Services. They collaborate with the CEO, Community...
* Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage...
* Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence - based guidelines...
* Review and sign off on proposed pharmacist denials for preservice outpatient medication requests, after review of medical records when provided...
* Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values...
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