Technical Skills: General knowledge of Medicare, TRICARE, or other government health care programs; knowledge in the application of clinical criteria: InterQual, PAS-LOS, ICD-10-CM, DSM, CPT, and HCPCS; proficient with Microsoft Word and Excel. • Refers cases for review as appropriate to Program Integrity, Case Management, Care Coordination, Population Health Improvement, Disease Management, Congressional Relations & Customer Grievances and other TriWest departments.