• Conduct comprehensive utilization reviews to determine medical necessity and level of care • Review medical records for documentation completeness and clinical appropriateness • Evaluate inpatient, outpatient, and procedural services for compliance with payer guidelines • Assist with preparation and review of demand packages for legal and insurance cases • Analyze cases involving payer disputes, denials, and recoupments • Prepare detailed, defensible written clinical review reports • Provide affidavit support, deposition preparation, and testimony when required • Interpret CMS guidelines, Medicare policies, and state-specific Medicaid requirements • Identify clinical risk, quality-of-care concerns, and documentation deficiencies