Responsibilities

• Configure appropriate tables and settings in the decision management and contact management applications; complete content build and revisions related to criteria and fax form intake requests to ensure review tools are available when expected
• Identify areas for improvement to prevent quality issues from recurring
• Analyze requests, develop and validate plans including assessment of relevant formulary data and/or Utilization Management (UM) policy for automation opportunity and potential impacts on tool performance and maintenance requirements
• Execute peer reviews or other quality measures to ensure all clinical review criteria and/or correspondence tools meet high quality standards and prevent quality issues from reoccurring; partner with internal teams (i.e., Testing, Training, Contact Center, Account Management) to research any discrepancies identified
• Provide support and educate internal partners (i.e., Clinical Call Center, Utilization Management, Service Delivery etc.) on appropriate use of the tools