Works collaboratively with Program Managers and other team members to:
Develop a review process for the prior and expedited authorization programs including development of supportive tools.
Review and evaluate available scientific evidence and specific program utilization data to make program
recommendations regarding services that should have prior or expedited prior authorization requirements. Use clinical knowledge and data to make recommendations in changes in level of authroization requirements and evaluate impact.
Coordinate utilization management projects; researches and evaluates the clinical implications of current and new medical policy for programs.
Advise Office Chief, Chief Medical Officer, Division Directors, and executive leadership regarding the need to edit/revise/author new regulation, policy or modifications to existing policy/regulation using data to support request.
Serve as a clinical resource and subject matter expert to both internal and external stakeholders for all clinical expedited authorization issues/questions related to appropriate Medicaid programs.
Collaborate statewide with stakeholders in the development of Medicaid program action plans, policy, criteria and training.
Research and evaluate the clinical implications of current and new medical policy for the prior and expedited authorization programs.
Research and retrieve cost and utilization data related to the prior and expedited authorization programs in response to stakeholder requests.
5% Performs bill analysis of proposed legislation affecting the FFS medical program as assigned.
5% Other duties as assigned.
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