Physician Specialist-NDC- Expert
Company: Staff Today Inc
Posted on: January 15, 2022
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
Basic computer skills to include, but not limited, to Microsoft
Resource in this position will serve as a physician reviewer for
Department of Public Welfare. Resource will provide utilization and
quality reviews of services for the Department.
Resource will conduct prospective, concurrent and retrospective
review of any assigned adult or pediatric inpatient and outpatient
medical cases covered by the Department including, but not limited
to: inpatient admissions; procedures performed in a physician' s
office, Short Procedure Unit or Ambulatory Surgical Center; home
health services; medical supplies; and/or diagnostic studies or
Resource shall be responsible for making determinations regarding
the medical necessity, place of service, appropriateness,
compensability, and/or quality of care of services prescribed for
and provided to Medicaid recipients. It will be the Resource' s
responsibility to review all requests thoroughly and make a
qualified determination in accordance with Medical Assistance
regulations and criteria. Depending on the type of case reviewed,
Resource will be required to 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.
The Resource will submit the above information to the Department
using formats specified by each individual Bureau.
Resource, when requested, will assist in the development of
in-house training programs, medically necessary criteria, and
quality of care indicators.
Resource may be asked to help the Department in determining if any
changes should be made to criteria or regulations to better serve
Keywords: Staff Today Inc, Harrisburg , Physician Specialist-NDC- Expert, Healthcare , Harrisburg, Pennsylvania
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