Physician Specialist NDC Expert
5 days ago
We are seeking a highly skilled Physician Specialist NDC Expert to join our team at Health Advocates Network, Inc.
Job Summary:The successful candidate will serve as a physician reviewer for the Department of Public Welfare, providing utilization and quality reviews of services for the Department.
Key Responsibilities:- Conduct prospective, concurrent, and retrospective review of adult and pediatric inpatient and outpatient medical cases covered by the Department.
- Make determinations regarding medical necessity, place of service, appropriateness, compensability, and/or quality of care of services prescribed for and provided to Medicaid recipients.
- Compile case findings, prepare summaries of case findings, make recommendations for case disposition, identify program violations, prepare appealed cases for hearings, and/or be available to testify at administrative hearings for cases under appeal.
- Submit information to the Department using formats specified by each individual Bureau.
- Assist in the development of in-house training programs, medically necessary criteria, and quality of care indicators.
- Help the Department in determining if any changes should be made to criteria or regulations to better serve their clients.
- Be board certified in the requested specialty.
- Possess an active Pennsylvania medical license.
- Be in active clinical practice in the area in which the Resource is board certified at least twenty (20) hours per month.
- Demonstrate an understanding of utilization review processes.
- Basic computer skills to include, but not limited to, Microsoft Office Products.
Health Advocates Network, Inc. is an equal opportunity employer. All qualified applicants shall receive consideration for employment without regard to any legally protected basis under applicable federal, state or local law, except where a bona fide occupational qualification applies.
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Harrisburg, Pennsylvania, United States Health Advocates Network Full timeJob Title: Physician Specialist NDC ExpertHealth Advocates Network, Inc. is seeking a highly skilled Physician Specialist NDC Expert to join our team.Job Summary:We are looking for a board-certified physician with expertise in utilization review processes to serve as a medical reviewer for the Department of Public Welfare. The successful candidate will...
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