Assists in the development and implementation of medical policy.
Assures compliance with medical policy.
Directs the efforts of the utilization review, case management, and pre-certification functions to accomplish objectives within policy and budget.
Performs medical reviews.
Oversees the quality management function in the identification and analysis of medical information to develop interventions to improve quality of care and outcomes and ensure proper provision for participants.
Review of safety data and pharmacology decisions.
Establishes and implements policies and standards, evaluates new treatments, and evaluates available data sources to ensure the quality of the medical care provided.