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Job Summary : Collaborate with Healthcare Provider(s) and Member(s) to Promote Quality Member Outcome(s), to Optimize Member Benefit(s), and to Promote the Effective Use of Resource(s). You will help Ensure that Medically Appropriate, High Quality, and Cost-Effective Care is Provided through Assessing the Medical Necessity of In-Patient Admission(s), Outpatient Service(s), Focused Surgical and Diagnostic Procedure(s), Out of Network Service(s), and Appropriateness of Treatment Setting by Utilizing Applicable Medical Policy and Cl...