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- Perform prospective, concurrent or retrospective utilization review/medical management for all services
- Screen individual situations according to specific criteria to determine if care is appropriate *Refer cases that fail to meet screening criteria to peer reviewer
- Coordinate and...
- Medical management and review for all services
- Telephonic care
- Screen medical situations - determine approvals or denials
- Research medical history, notes and documentations
- Provide technical assistance
- Conduct medical record review...