Administration

• Directs and oversees operations in the medical review, clinical pricing, and re-determination areas
• Supervises and motivates area employees
• Coordinates tactical team activities
• Ensures area review decisions are accurate and associates are well informed and trained on contract process work instructions
• Reviews and analyzes data; creates departmental strategy and error rate reduction plans
• Provides guidance on the analysis, identification, and corrective actions of services and/or providers with suspected abuse
• Works closely with the Provider Service Center and other internal departments
• Develops and monitors budget for all assigned areas

Medical Review Director

Medical Review Director