Work under the direction of the Chief Medical Officer of Post-Acute Care to review the appropriateness for requested Durable Medical Equipment and Post-Acute Care.

• Perform a full range of medical necessity reviews utilizing nationally accepted medical necessity criteria for Durable Medical Equipment and related supplies

• When necessary perform the full range of post-acute program medical necessity reviews utilizing nationally accepted medical necessity criteria for Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), and Long Term Acute Care Facility (LTAC) for admissions and length of stay appropriateness
• Utilize CMS guidelines, NCDs, LCDs, and appropriate guidelines (InterQual, Milliman and Robbins) in medical necessity determinations.
• Available for Peer to Peer consultations.
• Available to attending physicians and/or ordering providers to conduct peer to peer discussions concerning utilization management issues.
• Serve as an advisor on other clinical matters within area(s) of expertise.
• Support the Clinical Services Staff as needed.
• Participate in calls and meetings with clients as needed.
• Participate in special projects as needed.
• Assist in the Guidelines/Criteria updates as needed.
• Perform other duties as required by the Chief Medical Officer of Post-Acute Care.

• Board Certification in Physical Medicine and Rehabilitation with a current, valid and unrestricted license in the United States.
• Knowledge of applicable state and federal laws, URAC and NCQA standards.
• At least 5 years of experience in direct patient care.
• Medical Management Experience is desired.
• Rehabilitation Experience is desired.
• Communication and presentation skills strongly preferred