Healthcare Clinical Evaluator MD

Job Summary

A company is looking for a Healthcare Clinical Evaluator SME.

Key Responsibilities

• Review prior authorizations under the EPSDT program to determine medical necessity
• Collaborate with healthcare professionals to complete PA requests efficiently
• Manage incoming PAs and ensure compliance with service level agreements

Required Qualifications

• Education: MD/DO degree
• Experience: 15+ years of related experience
• Technical skills: Proficiency in Microsoft products and Adobe PDF