* Provide daily utilization oversight and external communication with network physicians and hospitals * Daily UM reviews - authorizations...
* Clinical leadership within Optum Serve and reports to the Chief Medical Officer, Community Care Services. They collaborate with the CEO, Community...
* Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values...
* Perform utilization review determinations for oncology populations, and support case and disease management teams to achieve optimal clinical...
* Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral...
* Conduct second level medical necessity/compliance status reviews for all payor types * Requirement to gain and sustain a working knowledge...
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