Lead Reviewing Physician Consultant (Bid)

Essential Duties and Responsibilities:
- As a physician consultant, access a secure portal to retrieve and work clinical cases; review each set of case records for the clinical history, diagnoses, current symptomatology, and current requested treatment(s).
- Research patient records for any relevant information consistent with the requested treatment(s) to obtain an accurate clinical picture of the status of the condition(s) present.
- Access the online version of the evidence-based state guidelines to decide which guideline pertains to the requested treatment, and then determine if there are associated criteria or circumstances when the requested medical treatment is appropriate.
- Analyse and compare the guideline to the pertinent case records to determine if the case meets, or does not meet, the criteria for the requested treatment.
- In cases where no state guideline pertains to the requested treatment, the physician must research for other approved secondary sources of peer-reviewed literature to support the decision, and then review and interpret that scientific literature to determine if it supports, or doesn't support, the requested treatment in that respective case.
- After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.

- Serve as the Contractor's lead reviewing physician and primary clinical liaison to the client.

- Conduct medical suitability reviews of pre-employment and incumbent medical examinations.

- Review and respond to medical consultation requests, providing expert-level determinations and recommendations.

- Ensure quality control of all medical ratings and consultations, including consistency, accuracy, documentation completeness, and alignment with medical standards.

- Interpret and apply federal, state, and local government medical standards, physical requirements, and occupational guidelines for law enforcement roles.

- Provide clinical expertise on medical guidelines, critical job tasks, environmental hazards, and stressors associated with law enforcement positions.

- Lead and guide alternate reviewing physicians as required.

- Maintain full compliance with all contract requirements, medical licensure obligations, and board-certification requirements.

Minimum Requirements

- Bachelor's Degree and minimum of 12 years of experience required.
- Must be an MD or DO with an active license to practice medicine with no disciplinary history.

- Current, active, and unrestricted license to practice medicine in any U.S.

state, territory, commonwealth, or the District of Columbia.

- Current board certification in Occupational Medicine or Internal Medicine, OR a minimum of three (3) years of experience providing medical suitability determinations for law enfor...