Qlarant has a home-based contract opportunity for a physician with experience providing hospice services. In this role, you will perform reviews of medical records and related documentation for medical necessity. In addition, this position supports review determinations during the appeals process including depositions and court testimony. It is preferred that the selected physician is located in California, but other states are acceptable if you have a current, active and unrestricted California clinical physician license.

Please note:  This is a contractual arrangement with an hourly rate.  There are no guaranteed hours as the work is assigned on an as needed basis. 

This position supports our Unified Program Integrity Contract (UPIC) team's efforts to identify and investigate the fraud, waste and abuse (FWA) impacting our nation's Medicare and Medicaid programs. Our Cerritos-based UPIC West team is responsible for FWA investigations covering 16 Western states and territories.

While medical review and support of review determinations will be the primary responsibilities of this position, the Medical Director job description includes the following essential duties and responsibilities. Other duties may be assigned.

• Provides clinical information to teams
• Medical Review Oversight may include:
• Physician peer review activities
• Criteria development and assessment
• Correspondence regarding review determination
• Recruitment, credentialing, and training of expert physician reviewers
• Managing the expert physician advisory network in specific geographic areas
• Serving on external committees
• Professional Relations may include:
• Interfacing with external organizations including physician specialty groups, hospital associations,  medical societies, affiliates contractors, and state and federal agencies
• Discussing specific clinical issues with attending physicians
• Health Care Quality Improvement/Assurance may include:
• Leading and/or participates in quality improvement projects as needed
• Providing clinical input to specific projects as required by the organization or contractors
• Supporting project managers or teams with specific collaborative projects as needed
• Maintaining working knowledge of current quality improvement issues and tools