Perform prospective, concurrent, and retrospective clinical reviews to ensure medical necessity and appropriate level of care. Coordinate discharge planning and manage appeal requests while maintaining compliance with regulatory and accreditation standards.
The Team Leader is responsible for supervising clinical staff, managing departmental operations, and ensuring compliance with corporate policies and regulatory standards. They will also conduct home visits for high-risk members and collaborate with medical professionals to develop effective treatment plans.
The Team Leader is responsible for supervising staff, managing departmental operations, and ensuring efficient utilization management processes. They will also collaborate with medical directors and healthcare providers to develop treatment plans and monitor quality metrics.
