Medicaid Physician Review and Consulting Services

The agency is seeking Medicaid physician review and consulting services. The agency requires medical oversight for clinical needs, prior authorization case review, and medical necessity determinations within a Medicaid managed care environment. The project covers providing expertise in competencies, knowledge, skills, abilities, and subject matter. Excellent verbal and written communication skills are essential, as are advanced analytical skills for reviewing clinical data from various sources including claims, medical records, guidelines, literature, and policies. Advanced interpersonal skills are also required for relationship building, teamwork, motivation, consensus building, negotiation, persuasion, facilitation, conflict resolution, tact, sensitivity, and confidentiality. Eligibility is limited to onshore organizations located within the USA. The performance of the work will be conducted offsite. The agency is looking for proposals.