Vermont Department of Economic Development #03410-245-27

Vermont Medicaid seeks licensed physicians for review and consulting services

The State of Vermont's Department of Vermont Health Access (DVHA) is seeking licensed physicians to provide consulting and review services for the Medicaid Managed Care program. - Government Buyer: - Department of Vermont Health Access (DVHA), State of Vermont - OEMs and Vendors: - No OEMs or product vendors are involved; this is a professional services procurement - Products/Services Requested: - Medical oversight and consulting services for Medicaid - Review of prior authorization requests for medical necessity - Support for adoption of clinical guidelines - Review of non-emergent medical transportation requests - Assistance to nurse case managers - Participation in case reviews and peer-to-peer coverage discussions - Involvement in appeals, fair hearings, and quality improvement activities - Unique or Notable Requirements: - Physicians must hold a current Vermont medical license - Minimum of one year of primary care or general medicine internship required - Board certification in an ABMS-approved specialty is preferred - Experience with complex medical needs and electronic health records - Must meet Vermont Medicaid credentialing standards - Services are provided on an as-needed basis, up to 10 hours per week

Description

The Department of Vermont Health Access (DVHA) is seeking proposals to contract with licensed physicians to provide medical oversight related to clinical needs, prior authorization review, and medical necessity determinations within a Medicaid Managed Care environment. The services focus on ensuring care is medically necessary and cost-efficient. The contract requires up to 10 hours per week on an as-needed basis. Primary responsibilities include reviewing prior authorization requests, supporting clinical guideline adoption, reviewing non-emergent medical transportation, assisting nurse case managers, participating in case reviews, peer discussions, appeals, and quality improvement activities.

View original listing