DVHA Medical Director RFP 03410-245-27.pdf

This is a Request for Proposals (RFP) issued by the Department of Vermont Health Access (DVHA) for Medicaid Physician Review and Consulting Services. The RFP solicits proposals from actively licensed physicians to provide medical oversight and clinical support to the department on an as-needed basis, not to exceed ten hours per week. Primary responsibilities include reviewing prior authorization requests for medical necessity determinations, supporting the Clinical Services Team in evaluating clinical information, reviewing non-emergent medical transportation requests, assisting nurse case managers with patient condition management questions, participating in monthly chronic care initiative case reviews, conducting peer-to-peer discussions with providers regarding coverage determinations, and participating in appeals and fair hearings as needed. The contract requires physicians to hold an M.D. or D.O. degree with a minimum of one year of primary care or general medicine internship experience and board certification in an ABMS-approved specialty.

The specific response dates, due dates, award dates, and contract term information are not provided in the available document excerpt. Pricing terms, set-aside provisions, funding sources, and amounts are similarly not detailed in the materials supplied. The position operates within a Medicaid Managed Care environment focused on ensuring medical necessity and cost efficiency rather than limiting access or generating profits, with scheduling to be mutually agreed upon between the contractor, the State Clinical Services Team Director, and the State's Chief Medical Officer.