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Physician Reviewer
DescriptionScope: Serves as an expert physician resource and reviewer.REPRESENTATIVE RESPONSIBILITIES???Medical ReviewPerforms medical review activities pertaining to delegated pediatric services including medical review of complex, controversial, or experimental medical services???QualityAssists Medical Director in improving quality and cost-effectiveness of care and service for members and provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, institutional, and accreditation requirements???UtilizationIdentifies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of be


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