• Physician - Internal Medicine

    EGA Associates (PA)


    Details

    **Client Name:** PA Health & Wellness

    **Job Type:** Travel

    **Position Urgency** Normal

    **Offering** Locums

    **Profession** Physician

    **Specialty** Internal Medicine

    **Job ID** 16155235

    Shift Details

    **Shift** 09:00 AM - 05:00 PM

    **Shifts Per Week** 1

    **scheduledHrs_1** 1.0

    Job Order Details

    **Start Date** 2025-03-31

    **End Date** 2026-11-01

    **Duration** 83 Week(s)

    **Float Required** No

    **Call Required** No

    **Required Certifications for Onboarding** AMA, DEA, NPI

    **Job Description** Physician Reviewer – Medicaid Grievance Hearings (1099 Contract Role)

    Schedule: As needed; standard business hours (9 AM – 5 PM EST)

    Contract Type: 1099 Independent Contractor

    Position Overview

    We are seeking board-certified physicians to serve as Vendor Physician Reviewers for Medicaid grievance cases. In this role, you will review clinical documentation and participate in member grievance hearings, providing expert medical opinions aligned with regulatory and organizational standards.

    Key Responsibilities

    Grievance Review Participation

     

    Review assigned Medicaid grievance cases within the specified timeframe.

    Participate in scheduled member hearings, with a minimum of 10 calendar days’ notice provided.

    Be available for expedited cases with 24-hour notice.

     

    Availability & Responsiveness

     

    Acknowledge receipt of grievance review requests within 1 business day.

    Be available during standard business hours (9 AM – 5 PM EST).

    Notify PHW of any scheduling conflicts at least 5 business days in advance to avoid cancellation penalties.

    Communicate immediately in case of emergency or technical issues preventing participation.

    Quality & Compliance

    Conduct thorough, unbiased reviews of all relevant documentation (e.g., PCSP, interRAI, SPG, AR, Appeal Summary).

    Ensure reviews are conducted in a private, quiet environment.

    Adhere to PHW policies, HIPAA regulations, and applicable state/federal guidelines.

     

    Documentation

     

    Submit clear, comprehensive findings and recommendations within 1 business day post-review.

     

    Communication & Collaboration

     

    Maintain open communication with PHW staff and grievance review committees.

    Respond promptly to queries or requests for additional information.

     

    Training & Development

     

    Participate in initial and annual grievance review training sessions as required by PHW’s Chief Medical Officer.

     

    Ethics & Integrity

     

    Disclose any potential conflicts of interest and recuse from cases where impartiality may be compromised.

    Client Details

    **Client Type** Commercial

    **State** PA

     

    EGA Associates, LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.