• Provides administrative oversight to the medical staff • Analyzes medical review utilization data • Researches new medical procedures or technology • Acts as a resource to providers and internal staff on medical policies • May write and revise medical policies • Develops claim adjudication criteria • Provides input on operational policies, processes, and procedures • Educates staff and medical community on medical policy and program administration • Develops external relationships with the medical community • Reviews physician and provider practice pattern analysis and other statistical data • Conducts research into new or controversial medical procedures and technology