Teams at Bradford Health Services

Reviews medical records, treatment plans, and clinical documentation to assess medical necessity and appropriate resource utilization. Coordinates with providers, insurers, and case managers to obtain information and secure timely authorizations. Makes authorization and service continuation decisions according to clinical guidelines and regulations, maintains compliant records, and monitors changes in payer policies and healthcare requirements.

Evaluate patient records, treatment plans, and clinical data to determine medical necessity and appropriateness of services; coordinate with providers, insurers, and case managers for authorizations; document decisions and ensure compliance with payer and regulatory guidelines; stay current on policies to optimize care and control costs.

Evaluate patient records, treatment plans, and clinical data to determine medical necessity and authorization decisions. Coordinate with providers, insurers, and case managers, document utilization review activities, and ensure compliance with payer policies and regulations to optimize patient outcomes and control costs.