Examining medical treatments and interventions to avoid payment denial and optimizing reimbursements by assessing the treatment’s appropriateness, effectiveness, timing, and setting. Evaluate treatment plans with a critical eye to ensure the patient receives the best care while determining what level of treatment is necessary. Collaborate with other case managers, physicians, and health care providers while searching for essential information to confirm the patient’s insurer authorizes services. Identify areas to improve the cost-effectiveness of care while maintaining quality, including reviewing the utilization of health care resources, such as the length of hospital stay, medications, therapies, and diagnostic tests.