Medical Necessity Specialist

6 days ago


Harrisburg, Pennsylvania, United States Health Advocates Network Full time
About the Role

Health Advocates Network, Inc. is seeking a highly skilled Medical Necessity Specialist to join our team. As a key member of our department, you will play a vital role in evaluating the medical necessity of services for Medicaid recipients.

Job Summary

This is a remote opportunity for an experienced physician with expertise in family practice medicine. The ideal candidate will possess excellent analytical and communication skills, with the ability to work independently and as part of a team.

Responsibilities
  • Evaluate the medical necessity of services for Medicaid recipients
  • Conduct prospective, concurrent, and retrospective reviews of medical cases
  • Make determinations regarding medical necessity, place of service, appropriateness, compensability, and quality of care
  • Compile case findings, prepare summaries, and make recommendations for case disposition
  • Assist in the development of in-house training programs and medically necessary criteria
Requirements

To be successful in this role, you will need:

  • A Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited medical school
  • Board certification in family practice medicine
  • An active Pennsylvania medical license
  • Excellent analytical and communication skills
  • Basic computer skills, including proficiency in Microsoft Office products
Compensation

The estimated annual salary for this position is $130,000-$140,000, depending on experience.

About Health Advocates Network, Inc.

We are an equal opportunity employer and value diversity in our workplace. We do not discriminate based on age, ancestry, color, disability, ethnicity, gender identity, national origin, race, religion, sex, sexual orientation, or any other characteristic protected by applicable law.


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