Medicaid Physician Review and Consulting Services

The Department of Vermont Health Access is soliciting proposals to contract with an actively licensed Physician(s) to provide medical oversight, prior authorization case review, and medical necessity determinations in a Medicaid Managed Care environment. The selected contractor will provide consultative services on these activities, on an as-needed basis, not to exceed sixteen (16) hours per week. The contract period will be for three years with an option to renew for up to two additional years. Key responsibilities include reviewing specific requests for medical services, rendering professional opinions, and working in collaboration with the State's Chief Medical Officer. * Provide medical oversight and prior authorization case review * Render professional opinions on medical necessity determinations * Collaborate with the State's Chief Medical Officer and other staff * Submit monthly records of activities and time spent reviewing cases * Maintain an active license to practice medicine in Vermont