Contract Administration: Activities include adhering to contractual requirements, of employer groups, beneficiaries, and health care providers.
Benefits Management: The division ensures that predefined populations receive health care coverage.
Policy and Medical Management: The division determines procedures and other health services that require prior approval from the MCO medical staff and makes the determination on what type of medical cases require a clinical review before authorization for care can be granted.
Provider and Member Services: Activities include providing customer service to policy holders and health care providers to ensure health care services are provided as agreed.
Of the above 4, are there any that stand out as more/less challenging? Why or why not?
Atleast 150 words and reference.