Part Time Healthcare Clinical Evaluator SME, MD Required

General Dynamics Information Technology; Myrtle Point (OR); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading technology and professional services organization is seeking a Healthcare Clinical Evaluator SME. This position involves reviewing prior authorizations for medical necessity, collaborating with healthcare teams, and contributing to public health initiatives. Candidates should have an MD/DO, NC Board-Certified, and possess over 15 years of relevant experience. This role offers a competitive salary and remote flexibility.

Benefits

Comprehensive benefits

401K with company match

Paid time off

Flexible work arrangements

Qualifications

• 15+ years of related experience required.
• Must possess MD/DO, NC Board-Certified.
• Proficient in Microsoft products and Adobe PDF.

Responsibilities

• Review prior authorizations under EPSDT program.
• Manage incoming PAs and meet service level agreements.
• Collaborate with Multidisciplinary teams for PA requests.

Skills

Clinical Guidelines

Clinical Practice

Medical Records Management

Education

MD/DO; NC Board-Certified

Tools

Microsoft products

Adobe PDF

Job description

Job Details

Type of Requisition: Regular

Clearance Level Must Currently Possess: None

Clearance Level Must Be Able to Obtain: None

Public Trust/Other Required: None

Job Family: Healthcare Services

Job Qualifications:

Skills: Clinical Guidelines, Clinical Practice, Medical Records Management

Certifications: None

Experience: 15 + years of related experience

US Citizenship Required: No

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.

MEANINGFUL WORK AND PERSONAL IMPACT

As a Healthcare Clinical Evaluator SME, the work you’ll 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 request
• 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; NC Board-Certified
• 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 guaranteed compensation or salary. 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 medical, dental, vision plans, and a 401(k) with company match. We offer paid time off, paid holidays, and leave programs. We are GDIT, a global technology and professional services company that delivers consulting, technology and mission services across the U.S. government, defense and intelligence community. Our 30,000 experts operate in 50 countries worldwide. Join our Talent Community to stay up to date on career opportunities and events.

Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans