DescriptionSummary:This position is responsible for analyzing clinical information submitted by medical providers to evaluate the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Is responsible for clinical review of all requested services for appropriateness based on clinical criteria. Performs selected member calls to address post hospital discharge services, ongoing durable medical equipment usage and other telephonic follow up identified by UM/CM Management. This position will facilitate with negotiations for out of network care.Proactively analyze information submitted by providers to make timely medical necessity review determinations based on appropriate criteria and standards