Licensed Clinician Reviewer MD/DO

Job Summary

To support the review of Long-Term Services and Supports (LTSS), Personal Assistance Services (PAS), and In-Home Supportive Services (IHSS), the independent contractor Licensed Clinician Reviewer MD/DO will conduct evidence-based medical necessity reviews remotely, ensuring compliance with state guidelines and rendering defensible determinations.

Key responsibilities

• Review case files and apply medical necessity criteria to determine the appropriateness of PAS/IHSS/LTSS services
• Render written determinations that clearly explain clinical rationales and address the appellant's appeal basis
• Maintain current knowledge of LTSS, PAS, and IHSS regulations and complete reviews within mandated turnaround times

Required qualifications

• Active, unrestricted medical license in one or more states
• Minimum of 3 years of clinical experience with elderly, disabled, or chronically ill patients requiring LTSS/PAS/IHSS
• Direct experience in recommending or certifying LTSS/PAS/IHSS services
• Board certification in a relevant specialty such as Internal Medicine or Geriatric Medicine
• Five years of active practice with direct patient care within the past year