Healthcare Clinical Evaluator SME

General Dynamics Information Technology; Myrtle Point (OR); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading technology and professional services company in the United States is seeking a Healthcare Clinical Evaluator SME. In this role, you will review prior authorizations, collaborate closely with medical staff, and ensure timely reviews under the EPSDT program. Candidates must possess an MD/DO and have over 15 years of experience in relevant fields. This position offers flexible remote work options and a competitive benefits package.

Benefits

Comprehensive benefits package

401K with company match

Paid time off

Full-flex work week

Qualifications

• 15+ years of related experience.
• Trustworthy adjudication of medical necessity for prior authorizations.

Responsibilities

• Review prior authorizations under the EPSDT program.
• Collaborate with medical staff to complete requests.
• Manage incoming PAs and meet service level agreements.

Skills

Health discipline expertise

Medical knowledge

Familiarity with Microsoft products

Proficiency with Adobe PDF

Education

MD/DO

Job description

Overview

HEALTHCARE CLINICAL EVALUATOR SR PRINCIPAL

Solve real-world challenges that impact the frontlines of public health, life science, and clinical research initiatives as a Healthcare Clinical Evaluator SME at GDIT. You will support the mission and grow with it, building a meaningful career in health.

Solve real-world challenges that impact the frontlines of public health, life science, and clinical research initiatives as a Healthcare Clinical Evaluator SME at GDIT. You’ll support the mission and grow with it, building a meaningful career in health.

Meaningful Work and Personal Impact

As a Healthcare Clinical Evaluator SME, the work you do at GDIT will be impactful to the mission of MD Healthcare Consultant. You will play a crucial role in reviewing prior authorizations (PAs) under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. You will be trusted to adjudicate PDN and DME prior approval requests to determine if the request is deemed medically necessary.

• Support teams by reviewing PAs in a timely manner, meeting all guidelines set by our customers
• Collaborate with the Medical Director, Physical Therapy, Nurses, and other staff to complete PA requests
• Collaborating with North Carolina Medicaid on PDN and DME cases
• Drive success by managing incoming PAs and meeting all service level agreements
• Utilize medical knowledge
• Your success will be measured through the delivery of quality prior approval reviews defined by service level agreements

What You’ll Need to Succeed

Bring your health discipline expertise and drive for innovation to GDIT. The Healthcare Clinical Evaluator SME must have:

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

GDIT is Your Place

At GDIT, the mission is our purpose, and our people are at the center of everything we do.

• Growth: AI-powered career tool that identifies career steps and learning opportunities
• Support: An internal mobility team focused on helping you achieve your career goals
• Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off
• Flexibility: Full-flex work week to own your priorities at work and at home
• Community: Award-winning culture of innovation and a military-friendly workplace

Own your opportunity. Explore a career in health at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your sense of purpose for making a difference.

The likely hourly rate for this position is between $80.20 - $0.00. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours: 8

Travel Required: None

Telecommuting Options: Remote

Work Location: Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most. We are GDIT. A global technology and professional services company that delivers consulting, technology and mission services to every major agency across the U.S. government, defense and intelligence community. Our 30,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50 countries worldwide, offering leading capabilities in digital modernization, AI/ML, Cloud, Cyber and application development. Together with our clients, we strive to create a safer, smarter world by harnessing the power of deep expertise and advanced technology. Join our Talent Community to stay up to date on our career opportunities and events at gdit.com/tc.

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans