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GENERAL SUMMARY OF POSITION: 

Under the general direction of the Director, or designee, the Medical Consultant is responsible for reviewing applicant medical records and making a clinical determination of eligibility for applicants seeking benefits and/or long term care services based on clinical guidelines.  The Medical Consultant also provides clinical guidance to reviewers and quality improvement initiatives as appropriate.

MAJOR RESPONSIBILITIES:

• Responsible for determining whether an individual applying for and/or receiving public assistance benefits/services meets specific clinical and functional criteria outlined in federal and state regulations.
• Conducts a comprehensive review of medical records and , provides recommendations to the clinical review team regarding the eligibility status of an applicant or member, .
• Contributes to quality improvement initiatives developed within the program or department.
• Participates in quality team case reviews.
• Collaborate with department leadership in the interpretation of all applicable regulations, development of clinical policies and quality evaluations, and provide feedback to clinical staff regarding clinical policies and the outcomes of quality evaluations.
• Evaluates and develops alternatives to address problems and issues as they arise on a case by case basis.
• Participates as a member of clinical or case review teams as necessary.
• Performs other duties as assigned.

REQUIRED QUALIFICATIONS:

• Board eligible or certified in area of specialty with 5 years of experience in direct patient care.

OR

• Nurse Practitioner with current licensure and 7 years of experience in direct patient care.
• Proven ability to plan and prioritize work in order to meet position objectives or job responsibilities.
• Excellent problem solving and decision making capabilities.

PREFERRED QUALIFICATIONS:

• Experience in the application of federal disability rules and regulations.
• Experience in direct patient care of individuals with brain injury, substance abuse and/or mental health. 
• Knowledge of long term care services and supports.

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