• Key member of the utilization management team focused on imaging • Serve as the Physician match reviewer in Imaging cases that do not meet medical necessity guidelines • Conduct specialty reviews when providers, clients, or state laws require subject matter expert review • Discuss determinations via peer-to-peer phone calls with requesting physicians within regulatory timeframes and provide clinical rationale for appeals • Utilize medical/clinical review guidelines to ensure consistency, appropriate utilization, and compliance with SBU policies, URAC and NCQA guidelines • Aid and act as a resource to Initial Clinical Reviewers • Ensure documentation of all communications with medical office staff and/or MD provider is recorded timely and accurately • May assist the Senior Medical Director in research activities/questions related to Utilization Management process, interpretation, guidelines and/or system support • Participate in on-going training per inter-rater reliability process • Routinely interact with leadership, other physicians, and staff when physician input is needed