Medicaid Physician Review and Consulting Services (RFP)

Description: Provide medical oversight, prior authorization case review and medical necessity determinations in a medicaid managed care environment. The state has policies and procedures within its clinical operations unit for surveillance and utilization review activities. These activities are federally mandated for all state medicaid managed care organizations, as outlined in title 42, part 400, of the code of federal regulations. The contractor(s) will provide consultative services on these activities, on an as needed basis, not to exceed ten (10) hours per week, according to a mutually agreeable schedule as established by the contractor, the state clinical operations unit director and the state s chief medical officer.