Healthcare Clinical Evaluator SME

Title: Healthcare Clinical Evaluator SME, MD Required

Location: USA Remote

Job Description:

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

None

Job Family:

Healthcare Services

Job Qualifications:

Skills:

Clinical Guidelines, Clinical Practice, Medical Records Management

Certifications:

None

Experience:

15 + years of related experience

US Citizenship Required:

No

Job Description:

HEALTHCARE CLINICAL EVALUATOR SR PRINCIPAL
Solve real-world challenges that impact the frontlines of public health, life science, and clinical research initiatives as a Healthcare Clinical Evaluator SME at GDIT. You’ll support the mission and grow with it, building a meaningful career in health.

MEANINGFUL WORK AND PERSONAL IMPACT
As a Healthcare Clinical Evaluator SME, the work you’ll do at GDIT will be impactful to the mission of MD Healthcare Consultant. You will play a crucial role in reviewing prior authorizations (PAs) under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. You will be trusted to adjudicate PDN and DME prior approval requests to determine if the request is deemed medically necessary.
● Support teams by reviewing PAs in a timely manner, meeting all guidelines set by our customers
● Collaborate with the Medical Director, Physical Therapy, Nurses, and other staff to complete PA request
● Collaborating with North Carolina Medicaid on PDN and DME cases

● Drive success by managing incoming PAs and meeting all service level agreements
● Utilize medical knowledge

●Your success will be measured through the delivery of quality prior approval reviews defined by service level agreements

WHAT YOU’LL NEED TO SUCCEED
Bring your health discipline expertise and drive for innovation to GDIT. The Healthcare Clinical Evaluator SME must have:
● Education: MD/DO
● Experience: 15+ years of related experience
● Technical skills: Microsoft products, Adobe PDF

GDIT IS YOUR PLACE
At GDIT, the mission is our purpose, and our people are at the center of everything we do.
● Growth: AI-powered career tool that identifies career steps and learning opportunities
● Support: An internal mobility team focused on helping you achieve your career goals
● Rewards: Comprehensive benefits and wellness packages, 401K with company match, and competitive pay and paid time off
● Flexibility: Full-flex work week to own your priorities at work and at home ***remove if ineligible***
● Community: Award-winning culture of innovation and a military-friendly workplace

OWN YOUR OPPORTUNITY
Explore a career in health at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your sense of purpose for making a difference.

The likely hourly rate for this position is between $80.20 - $0.00. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

8

Travel Required:

None

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most