Medical Review Officer (MRO) - 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 designated Medical Review Officer (MRO) for drug and alcohol testing conducted within job readiness and Drug-Free Workplace Program (DFWP) activities.

- Review and interpret laboratory test results to determine compliance and accuracy in accordance with federal and program standards.

- Conduct medical assessments or obtain additional medical information from participants when necessary to determine if there is a legitimate medical explanation for test results.

- Document all evaluations and final determinations in compliance with regulatory and program requirements.

- Ensure timely reporting of verified results to authorized program or case management personnel.

- Maintain strict confidentiality and adherence to HIPAA and other applicable privacy laws.

- Stay current with HHS, DOT, and other regulatory guidelines governing MRO responsibilities.

- Provide updated proof of all required licenses and certifications at proposal submission and at required six-month intervals.

- Collaborate with program leadership or testing vendors to address result discrepancies, regulatory questions, or process improvements.

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.

- Medical License: Permanent, full, and unrestricted license to practice medicine in a U.S.

jurisdiction.

- Board Certification: Board certified Do...