Care Review Clinician

• Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time.  

• Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.

• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.