Clinical Pharmacist

4 weeks ago


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

General Requirements:
Candidates must be located in or around the relevant region.

You may encounter various case types, including but not limited to:

  • Adult and child disability assessments.
  • Nursing home and Waiver level of care evaluations.
  • TEFRA childhood disability and care level inquiries.
  • Medicaid financial assessments.
  • Overpayment recovery cases.
  • Nursing home involuntary transfer or discharge matters.
  • Audits related to nursing homes.
  • Provider payment disputes.
  • Provider exclusion or suspension cases.
  • Denials or reductions in beneficiary services.
  • Managed Care Organization inquiries.
  • Provider post-payment reviews.
  • Hospital audit cases.

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 relevant criteria for Medicaid nursing home sponsorship.
  • Federal regulations regarding involuntary transfers and discharges in nursing homes.
  • Medicaid Managed Care Organization policies and procedures at both federal and state levels.
  • Provider billing and enrollment policies as set by SCDHHS.
  • Regulations and Medicaid policies concerning provider audits, post-payment reviews, exclusions, and suspensions.

Key Responsibilities:
  • Serve as an administrative hearing officer for the relevant department, conducting hearings and preparing official Orders and Final Administrative Decisions in compliance with established procedures.
  • Draft, authenticate, and publish Orders and Final Administrative Decisions in contested cases by accurately interpreting applicable statutes, case law, regulations, and policies.
  • Organize and facilitate hearing venues, including travel arrangements, and conduct evidentiary hearings while ensuring a comprehensive record is established.
  • Determine jurisdiction, develop issues in controversy, and establish Findings of Fact and Conclusions of Law based on evidence.
  • Conduct thorough research and analysis of laws, regulations, and policies related to the field.
  • If a petition for further review is filed, arrange for the review and certification of the case record.
  • Attend training sessions as required regarding the appeals process and other relevant topics.
  • 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 dedicated to delivering high-quality medical services and solutions. Our commitment to excellence is reflected in our comprehensive approach to patient care and administrative efficiency.


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