Medical Management Administrator Sample Clauses

Medical Management Administrator. Is an Arizona-licensed registered nurse, physician or physician‘s assistant if required to make medical necessity determinations, or has a Master‘s degree in health services, health care administration, or business administration if not required to make medical necessity determinations; Is responsible for the following primary functions: Consistently applies appropriate inpatient and outpatient medical necessity criteria; Conducts appropriate concurrent review and discharge planning of inpatient stays; Develops, implements and monitors care coordination and care management functions; Monitors, analyzes and implements appropriate interventions based on utilization data, including identifying and correcting over or under utilization of services; Oversees Arizona licensed nurses, physicians or physician‘s assistants to coordinate prior authorization, certification and recertification of need functions twenty-four (24) hours per day, seven (7) days per week; and Performs and coordinates concurrent review and retrospective review, including PASRR requirements.