Medical Advisor

• Review and adjudicate prior authorization requests based on medical necessity, eligibility, and state policy guidelines
• Evaluate clinical documentation and obtain additional information or clarification from providers
• Enter authorization determinations into the Medicaid Management Information System (MMIS)
• Serve as a clinical subject matter expert and resource for providers, internal teams, and external stakeholders
• Provide education and guidance to the provider community regarding prior authorization requirements and submissions
• Collaborate with leadership, operational teams, clinical peers, and state stakeholders to support program objectives
• Identify process improvement opportunities and recommend enhancements to supported medical programs
• Assist with reviewing provider and member communications related to new or revised policies and procedures

Explore Medical Expert at Gainwell Technologies. Review requirements and application details.