Job Information
Michigan Department of Health and Human Services Clinical Consultant / prior authorization reviews / part time – nurse practitioner or physician assistant in Lansing, Michigan
The Clinical Consultant serves in the Office of Medical Affairs, which is housed in MDHHS Health Services and provides clinical support to Michigan Medicaid. Utilizing clinical expertise and knowledge of program policies, the Clinical Consultant performs prior authorization reviews for Michigan Medicaid under physician oversight. This work is accomplished through review of clinical and administrative documentation to inform decisions in response to requests for coverage of pharmaceuticals under the pharmacy benefit. This work may also include similar reviews for clinical services, procedures, pharmaceuticals, supplies, and/or equipment requested under the medical benefit. This position may participate in administrative appeal hearings for prior authorization cases when necessary. Depending on programmatic needs, this position may also provide clinical consultation for other tasks in the Office of Medical Affairs.