Licensed Clinician Reviewer MD/DO

To support the review of Long-Term Services and Supports (LTSS), Personal Assistance Services (PAS), and In-Home Supportive Services (IHSS), the independent contractor Licensed Clinician Reviewer MD/DO will conduct evidence-based medical necessity reviews remotely, ensuring compliance with state guidelines and rendering defensible determinations. Key responsibilities Review case files and apply medical necessity criteria to determine the appropriateness of PAS/IHSS/LTSS services Render written determinations that clearly explain clinical rationales and address the appellant's appeal basis Maintain current knowledge of LTSS, PAS, and IHSS regulations and complete reviews within mandated turnaround times Required qualifications Active, unrestricted medical license in one or more states Minimum of 3 years of clinical experience with elderly, disabled, or chronically ill patients requiring LTSS/PAS/IHSS Direct experience in recommending or certifying LTSS/PAS/IHSS services Board certification in a relevant specialty such as Internal Medicine or Geriatric Medicine Five years of active practice with direct patient care within the past year