North Carolina Licensed Clinical Evaluator

Job Summary

A company is looking for a Healthcare Clinical Evaluator SME, MD Required.

Key Responsibilities

• Review prior authorizations (PAs) under the EPSDT program and adjudicate PDN and DME prior approval requests
• Collaborate with the Medical Director, Physical Therapy, Nurses, and other staff to complete PA requests
• Manage incoming PAs and ensure compliance with service level agreements

Required Qualifications

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