Job Description
Essential Duties and Responsibilities As a physician consultant, access a secure portal to retrieve and work clinical cases; review each set of case records for the clinical history, diagnoses, current symptomatology, and current requested treatment(s). Research patient records for any relevant information consistent with the requested treatment(s) to obtain an accurate clinical picture of the status of the condition(s) present. Access the online version of the evidence-based state guidelines to decide which guideline pertains to the requested treatment, and then determine if there are associated criteria or circumstances when the requested medical treatment is appropriate. Analyse and compare the guideline to the pertinent case records to determine if the case meets, or does not meet, the criteria for the requested treatment. In cases where no state guideline pertains to the requested treatment, the physician must research for other approved secondary sources of peer-reviewed literature to support the decision, and then review and interpret that scientific literature to determine if it supports, or doesn't support, the requested treatment in that respective case. After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service. Serve as the Contractor's lead reviewing physician and primary clinical liaison to the client. Conduct medical suitability reviews of pre-employment and incumbent medical examinations. Review and respond to medical consultation requests, providing expert-level determinations and recommendations. Ensure quality control of all medical ratings and consultations, including consistency, accuracy, documentation compl