Medicaid Physician Review and Consulting Services

The Vermont Department of Vermont Health Access, located in Waterbury, Vermont, is seeking Medicaid physician review and consulting services. The agency requires medical oversight, prior authorization case review, and medical necessity determinations within a Medicaid managed care environment. The selected contractor must render professional opinions on medical necessity for assigned services and procedures using evidence-based literature, accepted medical standards of care, and expert medical opinion. The agency needs the contractor to collaborate with the state chief medical officer on utilization management activities. The contractor will also work with Medicaid clinical staff in quality improvement, chronic care, program integrity, and pharmacy to identify areas of concern in the utilization program. The performance of all requested work will take place offsite. The agency is limiting eligibility to United States organizations only. The contract period will span one year, and the agency is currently looking for budget proposals. Bidders must submit all questions regarding this opportunity no later than June 5, 2026.