Cornerstone of Recovery

• Review and analyze medical records, treatment plans, and clinical documentation to assess the necessity and appropriateness of healthcare services. • Coordinate with healthcare providers, insurance representatives, and case managers to obtain additional information and clarify treatment details. • Make informed decisions regarding authorization, continuation, modification, or denial of services based on clinical guidelines and regulatory requirements. • Maintain accurate and detailed records of utilization review activities, decisions, and communications in compliance with organizational policies and legal standards. • Stay current with evolving healthcare regulations, payer policies, and clinical best practices to ensure consistent and compliant review processes.

• Identify and qualify new business opportunities through research, networking, and outreach within the health care sector. • Engage with prospective clients via phone calls, emails, and meetings to understand their challenges and present appropriate health care service solutions. • Collaborate with internal teams to develop customized proposals and presentations that meet client requirements and regulatory standards. • Maintain accurate records of client interactions and sales activities using CRM software to track progress and forecast potential revenue. • Stay informed about industry trends, competitor offerings, and regulatory changes to provide insights that support strategic decision-making.