• Perform timely clinical adjudication of dental claims and prior authorization requests • Determine medical necessity and benefit coverage using clinical expertise and plan guidelines • Interpret radiographs, charts, and supporting documentation to inform decisions • Identify inappropriate, unnecessary, or low-value services • Participate in quality improvement initiatives, audits, and utilization analyses • Conduct focused chart reviews to identify utilization trends and potential quality concerns • Support SIU activities, including provider site reviews and corrective recommendations • Analyze treatment patterns and recommend improvements • Conduct peer-to-peer consultations with network providers • Participate in grievance, appeal, and secondary review processes • Collaborate with specialists or subject-matter experts as needed • Participate in calibration sessions, trainings, and interrater reliability activities • Attend clinical and operational meetings • Contribute to credentialing and quality committees • Provide clinical input during tele-dentistry consultations when needed • Maintain expertise in dental benefit plans and Medicaid program requirements • Support regulatory reporting and compliance initiatives

• Conduct in-home infusion therapy visits with patients according to the plan of care. • Prepare clinical/nursing notes and document patient interventions in both clinical and non-clinical records consistently. • Act as a clinical resource, working collaboratively with other pharmacy departments. • Maintain knowledge of drug side effects and interactions. • Offer telephone and in-person patient education on therapy protocols, drug side effects, and home infusion procedures. • Ensure patients understand their therapy plans, medications, and the importance of adherence. • During initial and ongoing consultations, serve as a patient liaison between the patient, their family, and the pharmacy to ensure a seamless therapy process. • Perform comprehensive, initial, and periodic head-to-toe assessments for patients and initiate preventative and rehabilitative care. • Use health assessment data, and input from the agency team, the physician, the patient, and the family to determine patient needs. • Manage patient and family expectations regarding services, outcomes, and discharge goals. • Establish primary and secondary diagnoses based on patient assessment and home health care focus. • Develop care plans with skilled interventions, medical supplies, and necessary services to meet goals. • Regularly evaluate patient progress, in collaboration with team members, and revise care plans as needed. • Perform other duties as assigned.