**It's more than a career, it's a calling.**

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**Worker Type:**

Regular

**Job Summary:**

Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to support services provided by hospital. Ensures hospital receives authorization from payor.

**Job Responsibilities and Requirements:**

PRIMARY RESPONSIBILITIES

+ Discusses with payor regarding criteria and payor decision.
+ Escalates denials to physician (advisor, attending consultant, outside consultant) for peer to peer consideration.
+ Documents outcome in electronic medical record.
+ Participates with other members of team regarding opportunities for improvement in standard work.
+ Performs review of pre-admission, perioperative, and post operative surgical cases.
+ Performs other utilization management tasks as assigned.
+ Applies the existing body of ev...