Surgeon (Non-direct care) (73926)
About The Position
MHM Solutions, a Centurion company, is proud to be the provider of healthcare staffing solutions to state agencies within the Commonwealth of Pennsylvania. We are currently seeking a Surgeon to join our team and provide non-direct care to the Bureau of Program Integrity (BPI) within the Office of Medical Assistance Programs (OMAP). This position is up to 25 hours/week with a combination of remote and on-site work at the office in Harrisburg, PA. The surgeon will provide the BPI with consultation for retrospective medical record reviews of assigned inpatient and outpatient surgical cases covered by the Department in the fee-for-service and managed care delivery systems, including, but not limited to: inpatient admissions, procedures performed in a physician’s office, short procedure unit or ambulatory surgical center, rehabilitation facility services, home health services, medical supplies, and/or diagnostic studies or procedures. The surgeon shall be responsible for making determinations regarding the medical necessity, place of service, appropriateness, compensability, and/or quality of care of services prescribed for and provided to Medical Assistance (MA) beneficiaries. It will be the surgeon's responsibility to review all medical records thoroughly and make a qualified determination in accordance with the Medical Assistance regulations and policies.
Requirements
- Board certified in surgery
- Possess an active, clean Pennsylvania medical license
- Be in active clinical practice in the area in which the consultant is board certified at least 20 hours per month
- Demonstrate an understanding of utilization review processes
- Possess basic computer skills, including familiarity with Microsoft Office packages
Responsibilities
- Provide the BPI with consultation for retrospective medical record reviews of assigned inpatient and outpatient surgical cases covered by the Department in the fee-for-service and managed care delivery systems
- Make determinations regarding the medical necessity, place of service, appropriateness, compensability, and/or quality of care of services prescribed for and provided to Medical Assistance (MA) beneficiaries
- Review all medical records thoroughly and make a qualified determination in accordance with the Medical Assistance regulations and policies.
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
