Pricing Manager collaborating with Regional Medical Directors for evidence-based clinical decisions. Conducting clinical reviews and making crucial approvals or recommendations regarding cases.
Responsibilities
Works with Regional Medical Directors to make sound, evidence based clinical decisions regarding the requested cases (treatments and procedures) for IP/OP
Performs retrospective clinical reviews utilizing criteria set forth by the client and Medicare (CMS-Centers for Medicare and Medicaid Services)
Performs outbound calls to providers.
Requirements
Bachelor Degree in relevant field with 6- 8 years of relevant experience
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