• Implements and supports the philosophy, mission, values, standards, policies, and procedures of The Ohio State University Wexner Medical Center • Functions within the multidisciplinary team to secure complex pre-authorizations and prevent/appeal clinical denials • Utilizes clinical knowledge to interpret and apply medical necessity guidelines • Makes determinations on the appropriate level of care • Maintains awareness of State and National Health care trends, JCAHO, CMS, and third-party payer Utilization Management guidelines • Must be able to read, understand and interpret a payer remit, denial/remark codes, and expected reimbursement to determine the cost effectiveness of completing an appeal • Must be versatile, flexible, and very adaptable to change