Decision-making skills. • Monitor the daily work; • Evaluate the medical records, approving or rejecting applications ensuring compliance • Keep abreast of compliance guidelines and state specific regulations. • Respond to declination/appeal inquiries using established procedures. • Completes risk referrals, providing approval and/or feedback, and documenting quality assurance results. • Should be able to review prescription , lab, X-Ray or ECG/EKG report.