Commission for Case Manager Certification (CCMC) Practice Exam 2025 - Free Case Manager Certification Practice Questions and Study Guide

The medical director holds the authority to deny healthcare services because their role typically involves overseeing clinical practices and ensuring that medical guidelines and policies are followed within a healthcare facility. The medical director is responsible for making critical decisions regarding patient care and resource allocation, which includes the authority to approve or deny requests for specific healthcare services based on medical necessity and appropriateness. This position requires a comprehensive understanding of clinical standards and the ability to interpret medical necessity in the context of the organization's protocols.

The other roles mentioned do not hold the same level of authority. For instance, the utilization management registered nurse may play a significant role in reviewing cases and recommending decisions based on clinical criteria, but the final authority to approve or deny services typically rests with the medical director. Patients can express their preferences or request services, but they do not have the power to deny services. The appeals committee is involved in the review process for denied services and might overturn decisions, but they do not initiate denial themselves. Thus, the medical director’s position uniquely combines clinical oversight with the authority to make final determinations regarding healthcare service provisions.