Independent Medical Reviewer roles available for Family Medicine

Maximus is seeking a Family Practice MD/DO for a new project- CA DMHC Med Survey.

Travel is required!

Type of Service:

• Quality Review

Description:

• CA-DMHC Med Survey performs routine (once every three years), follow-up and non-routine surveys of its licensed managed health care plans to ensure the plans meet their obligations under the law and consumers have access to the high-quality health care to which they are entitled. DMHC has oversight for commercial and some Medi-Cal (Medicaid) managed health care plans..

Systems and Tools:

• The DMHC utilizes detailed audit tools when conducting medical surveys of both licensed full service and specialty plans to ensure compliance with the Knox-Keene Act (Act), Title 28 of the California Code of Regulations and other applicable laws and regulations. DMHC developed word documents called Technical Assistance Guides (TAGs) for each survey area. These are used by the surveyors to evaluate a health plan's policies and procedures and determine compliance. The TAG tools are updated as necessary based on legislative and regulation changes. The DMHC has also developed File Review Worksheets (FRWs), which are excel documents used to conduct case file review to ensure managed health care plans are appropriately providing services and following their policies and procedures. There are specific behavioral health, vision, and dental technical assistance guidelines as well.

Training:

• Training it's pretty flexible , but generally, we could say 20 hours of reviewing job aids/working on own and then shadowing one-two surveys which is generally 12 hours or so per survey-these are rough numbers-and the training is paid for by the project and training is remote.

Deliverable:

• Links Surveyor will be working as an independent consultant to perform surveys of California managed health care plans to determine compliance with state law. Each survey is conducted in three phases: pre-onsite, onsite, and post-onsite.
• Specifically, the surveyor is responsible for:
• Pre-onsite: Electronic review and completion of pre-survey paperwork utilizing CA-DMHC audit tools: work includes review of plan documents and completion of Technical Assistance Guide (TAG), review of plan files and completion of File Review Worksheet(FRW), preparation for onsite interviews. There is at least one pre-onsite meeting with the client prior to going onsite.
• Onsite: Traveling onsite to the health care plan offices for approximately 3-5 days to conduct interviews and additional document review as needed.
• Post-onsite: Documentation of findings and completion of survey and post-survey paperwork and reports utilizing CA-DMHC audit tools and templates.

LOE:

• Approximately 100 hrs over a 2.5-month period

Due Dates:

• Approximately 2.5 months

Anticipated Volumes:

• P/T Consulting Opportunity/100 hours per survey over a 2.5-month period but can be more or less.

As a leading strategic partner to governments across the globe, Maximus helps improve the delivery of public services amid complex technology, health, economic, environmental, and social challenges. With a deep understanding of program service delivery, acute insights that achieve operational excellence, and an extensive awareness of the needs of the people being served, our employees advance the critical missions of our partners. Maximus delivers innovative business process management, impactful consulting services, and technology solutions that provide improved outcomes for the public and higher levels of productivity and efficiency of government-sponsored programs. For more information, visit maximus.com.