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Clinical Pharmacist

3 months ago

Sharjah, Sharjah, United Arab Emirates NMC Healthcare Ltd Full time

General Requirements:
Candidates must be located in or around the designated area.

You may encounter various types of cases that fall under the jurisdiction of the relevant health department, including but not limited to:

  • Disability assessments for adults and children.
  • Nursing home and waiver care evaluations.
  • Childhood disability determinations under TEFRA.
  • Financial assessments for Medicaid.
  • Recoupment of overpayments.
  • Involuntary transfers or discharges from nursing homes.
  • Audits of nursing home facilities.
  • Payment disputes with providers.
  • Exclusions or suspensions of providers.
  • Denials or reductions of beneficiary services.
  • Managed care organization assessments.
  • Post-payment reviews of providers.
  • Audits of hospital facilities.

Experience Requirements:
If you are not a licensed attorney, you must possess a minimum of two (2) years of relevant experience in at least one of the areas listed below, along with supporting documentation and references.

Preference will be given to attorneys with experience and knowledge in the following areas:

  • Social Security disability determination processes for adults and children, including the sequential evaluation process.
  • Federal and state Medicaid eligibility policies and procedures, encompassing all eligibility categories and the criteria for Medicaid nursing home sponsorship.
  • Federal regulations regarding involuntary transfers and discharges from nursing homes.
  • Medicaid managed care organization policies and procedures at both federal and state levels.
  • Provider billing and enrollment policies as established by the health department.
  • Regulations and Medicaid policies concerning provider audits, post-payment reviews, exclusions, and suspensions.

Key Responsibilities:
  • Serve as an administrative hearing officer for the health department, conducting hearings and preparing orders and final decisions in compliance with administrative procedures.
  • Draft, authenticate, and publish orders and final decisions in contested cases by accurately interpreting relevant statutes, case law, regulations, and policies.
  • Organize and facilitate hearing venues, traveling as necessary to conduct evidentiary hearings while ensuring a comprehensive record is established.
  • Determine jurisdiction and develop issues in controversy, establishing findings of fact and conclusions of law based on evidence.
  • Conduct thorough research and analysis of laws, regulations, and case law, along with program policies and procedures.
  • In cases where further review is requested, arrange for the review and certification of transcripts and case records.
  • Attend training sessions as directed regarding the appeals process and related training for the Medicaid program.
  • Provide reliable transportation and internet connectivity as part of the role.

Compensation:
Consultant/1099 based on the complexity of each case.

About NMC Healthcare Ltd:


NMC Healthcare Ltd is a leading healthcare provider with a commitment to delivering high-quality medical services and patient care. Our team is dedicated to ensuring the best outcomes for our patients through innovative practices and comprehensive healthcare solutions.