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.
- 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.


















