The Pediatrician will counsel, advice and strategically direct, incorporating a clinical point of view. S/he will perform tasks as assigned, which may include comprehensive medical record and claim reviews for medical necessity, interpretation of code set application, adherence to regulation, terms of coverage, utilization, practice guidelines, quality improvement guidance, insights on new clinical interventions including policy, systems infrastructure, and clinical insights, and any other client directive.

Education/Experience

• Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.)

• Graduate from an accredited medical school in the United States or Canada

• Board certified

• Current experience in Pediatrics, with a minimum of one (1) year of experience within the past three (3) years

• Successful completion of an internship and residency program

• Subsequent to obtaining a Doctor of Medicine or Doctor of Osteopathy degree, a candidate must have had at least 1 year of supervised experience providing direct service in a clinical setting (i.e., a 1-year internship or the first year of a residency program in a hospital or an institution accredited for such training)

  • Graduate training programs include only those internship, residency, and fellowship programs that are approved by accrediting bodies recognized within the United States or Canada

• Certified by the American Board of Pediatrics and maintain certification in Pediatrics

• An internship program involves broadly based clinical practice in which physicians acquire experience in treating a variety of medical problems under supervision (e.g., internal medicine, surgery, general practice, obstetrics-gynecology, and pediatrics)

• A residency program involves training in a specialized field of medicine in a hospital or an institution accredited for training in the specialty by an appropriate accrediting body

• A fellowship program involves advanced training (beyond residency training) in a given medical specialty in either a clinical or research setting in a hospital or an institution accredited in the United States for such training

• Have and maintain a valid, unrestricted state license in any state in the United States, District of Columbia, or the territory of Puerto Rico to practice medicine, and a current Drug Enforcement Administration (DEA) registration. The licenses and registration must be renewed and maintained in a current status during the life of the contract