Conduct second level medical necessity/compliance status reviews for all payor types Requirement to gain and sustain a working knowledge of the technical systems to perform case reviews Meet with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status through case reviews Interacting with medical staff to discuss medical necessity and concurrent denial cases Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation Participate in the claims denial process by conducting peer to peer discussions with commercial payor medical directors for cases that have been denied concurrently Coordinate with Optum/OPAS Subject Matter Expert(s) for questions regarding federal, state and payor and regulatory requirements Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application Provide focused case by case education on utilization management topics (e.g., documentation) to the medical and UM staff Develop and maintain a working knowledge and understanding of OPAS proprietary guidance regarding clinical diagnoses and disease states. Initial and ongoing training will be provided by OPAS