• Serve as the Physician Clinical Reviewer for Interventional Pain Management, reviewing cases that do not initially meet the applicable medical necessity guidelines • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process • Provides clinical rationale for standard and expedited appeals • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner • Participates in on-going training per inter-rater reliability process • May function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management