Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.
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 Mississippi, but other states are acceptable if you have a current, active and unrestricted Mississippi 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.
To perform the job successfully, an individual should demonstrate the following competencies:
Other Skills and Abilities:
Education and/or Experience:
Certificates, Licenses, Registrations: Valid, current, active, and unrestricted Mississippi clinical physician license and practice as a health professional in a state or territory of the United States.
Travel Requirements: Travel requirements vary based on contract requirements may require periodic overnight and/or local travel. Must be willing to travel in accordance with company and contract needs.
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.