Primary duties may include, but are not limited to: Maintains the quality and timeliness of peer clinical and/or appeal case review decision making across all product lines, consults with team members to ensure consistency, and superior customer service, improves service to clients and unit productivity through continuous enhancement of whole team clinical knowledge and enhanced understanding of company systems, products, programs, procedures and customers. Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, and 5 years clinical experience ; or any combination of education and experience, which would provide an equivalent background.