Working closely with the Home Health RN Lead, UM nursing staff, and network providers, you will apply CMS regulations, National/Local Coverage Determinations (NCD/LCD), Milliman Care Guidelines (MCG), and health plan medical policies to drive evidence-based care, ensure appropriate resource utilization, and improve health outcomes. In this position, you will serve as the primary clinical authority for home health authorization requests while supporting acute, post-acute, appeals, reconsiderations, and outpatient medical necessity reviews for Medicare Advantage populations.