Develops and implements departmental initiatives and oversees retrospective medical record reviews, both on-site and in provider settings. Oversee the categorizing and recording of each document associated with retrospective reviews in the appropriate system(s). Manages in-house staff, vendors and vendor contracts for retrospective review process. Ensures 95% or greater of appropriate determinations and recommendations for members based on established criteria including CAF/PRI compatibility, CM recommendations, and NHC recommendations. Implements, monitors, and evaluates NHC process. Trains and acts as a resource to all staff and makes recommendations for changes in policy, procedures, and workflows as deemed appropriate.