Evaluation, interpretation, and processing of clinical review requests to include but not limited to applying the following requirements. Validation that requests has met submission requirements based on accreditation / governmental regulation requirements. Educate and/or communicate with provider offices on appropriate procedures. Application of internal policies and procedures, contractual provisions, and regulatory requirements. Multi-system v...
Description. Medical Management Specialist I. Location: This position will work full-time in the Richmond, VA office. Schedule: Monday-Friday 8am-5pm EST. The. Medical Management Specialist I. is responsible for providing non-clinical support to the Medical Management and/or Operations areas. Primary duties may include, but are not limited to. Gathers clinical information regarding case and determines appropriate area to refer or assign case (uti...
