Healthcare Clinical Evaluator SME, MD Required

General Dynamics Information Technology; Fairfax (VA); On-site; USD 80,000 - 100,000; Full time

Job summary

A global technology and professional services company is seeking a Healthcare Clinical Evaluator to review prior authorizations and collaborate with medical teams. The ideal candidate will have an MD/DO and over 15 years of relevant experience. This role offers competitive pay, a comprehensive benefits package, and flexible work options.

Benefits

Comprehensive benefits and wellness packages

401K with company match

Paid time off

Full-flex work week

Award-winning culture of innovation

Qualifications

• 15+ years of related experience required.

Responsibilities

• Review prior authorizations (PAs) under the EPSDT program.
• Support teams by reviewing PAs in a timely manner.
• Collaborate with the Medical Director and other staff.
• Drive success by managing incoming PAs according to SLAs.
• Utilize medical knowledge to inform PA decisions.

Skills

Clinical Guidelines

Clinical Practice

Medical Records Management

Microsoft products

Adobe PDF

Education

MD/DO

Job description

Overview

Req ID: RQ207835

Type of Requisition: Casual

Clearance Level Must Be Able to Obtain: None

Public Trust/Other Required: None

Job Family: Healthcare Services

Skills: Clinical Guidelines, Clinical Practice, Medical Records Management

Experience: 15 + years of related experience

Job Description: 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’ll support the mission and grow with it, building a meaningful career in health.

Responsibilities

• Review prior authorizations (PAs) under the EPSDT program and adjudicate PDN and DME prior approval requests to determine medical necessity.
• Support teams by reviewing PAs in a timely manner, meeting all guidelines set by customers.
• Collaborate with the Medical Director, Physical Therapy, Nurses, and other staff to complete PA requests.
• Collaborate with North Carolina Medicaid on PDN and DME cases.
• Drive success by managing incoming PAs and meeting service level agreements.
• Utilize medical knowledge to inform PA decisions.
• Performance will be measured by delivery of quality prior approval reviews defined by SLAs.

Qualifications

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

Why GDIT

• 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. Salary will be set based on experience, location, and contractual requirements and could fall outside of this range.

Our benefits package for all US-based employees includes a variety of medical plan options, dental, vision, and a 401(k) plan with company match. GDIT offers paid time off plans including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. New employees typically receive 15 days of paid leave per year, plus 10 paid holidays. The GDIT Paid Family Leave program provides up to 160 hours of paid leave in a rolling 12-month period. Additional offerings include short and long-term disability, life, accidental death and dismemberment, personal accident, critical illness, and travel insurance. Total Rewards are reviewed regularly to stay competitive.

We are GDIT. A global technology and professional services company delivering consulting, technology and mission services to U.S. government agencies, defense and intelligence communities. We operate in 50 countries with capabilities in digital modernization, AI/ML, Cloud, Cyber and application development.

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans