Lead Reviewing Physician Consultant; Bid

Essential Duties and Responsibilities

• As a physician consultant, access a secure portal to retrieve and work clinical cases; review each set of case records for the clinical history, diagnoses, current symptomatology, and current requested treatment(s).
• Research patient records for any relevant information consistent with the requested treatment(s) to obtain an accurate clinical picture of the status of the condition(s) present.
• Access the online version of the evidence-based state guidelines to decide which guideline pertains to the requested treatment, and then determine if there are associated criteria or circumstances when the requested medical treatment is appropriate.
• Analyse and compare the guideline to the pertinent case records to determine if the case meets, or does not meet, the criteria for the requested treatment.
• In cases where no state guideline pertains to the requested treatment, the physician must research for other approved secondary sources of peer-reviewed literature to support the decision, and then review and interpret that scientific literature to determine if it supports, or doesn't support, the requested treatment in that respective case.
• After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
• Serve as the Contractor's lead reviewing physician and primary clinical liaison to the client.
• Conduct medical suitability reviews of pre-employment and incumbent medical examinations.
• Review and respond to medical consultation requests, providing expert-level determinations and recommendations.
• Ensure quality control of all medical ratings and consultations, including consistency, accuracy, documentation completeness, and alignment with medical standards.
• Interpret and apply federal, state, and local government medical standards, physical requirements, and occupational guidelines for law enforcement roles.
• Provide clinical expertise on medical guidelines, critical job tasks, environmental hazards, and stressors associated with law enforcement positions.
• Lead and guide alternate reviewing physicians as required.
• Maintain full compliance with all contract requirements, medical licensure obligations, and board-certification requirements.

• Bachelor's Degree and minimum of 12 years of experience required.
• Must be an MD or DO with an active license to practice medicine with no disciplinary history.
• Current, active, and unrestricted license to practice medicine in any U.S. state, territory, commonwealth, or the District of Columbia.

• Current board certification in Occupational Medicine or Internal Medicine, OR a minimum of three (3) years of experience providing medical suitability determinations for law enforcement candidates and incumbents.
• Minimum five (5) years of experience reviewing and determining medical qualifications based on occupational standards for pre-employment and incumbent personnel within the occupational medicine field.
• Minimum three (3) years of experience providing medical suitability determinations for law enforcement and / or military entities, applying relevant medical standards and physician requirements.
• Demonstrated extensive knowledge of:
  • Medical guidelines and standards for government (local, state, Federal) law enforcement positions.
  • Physical demands and critical job tasks associated with law enforcement roles.
  • Environmental hazards and occupational stressors affecting law enforcement personnel.

Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market…