Constellation Quality Health

• The Physician Consultant supports Constellations payment integrity work, both directly and under contract with our partners. • This position is responsible for conducting detailed reviews of medical records to determine appropriateness of treatment, timelines and fact chronology, determination of reasonable and necessary treatment modality, causation, and medical necessity. • This includes assessing consistency between diagnosis, procedures, and clinical documentation. • The Physician Consultant works collaboratively with program staff to provide expert opinions on care provided to patients. • Develops formal, professionally written summaries of those opinions based on evidence and accepted practice standards.

• Conduct detailed reviews of clinical records to determine appropriateness of treatment, timelines and fact chronology, determination of reasonable and necessary treatment modality, causation, and medical necessity. • Assess consistency between diagnosis, procedures, and clinical documentation. • Document expert opinion of clinical findings, assessment of care, and utilization of practice standards in a professionally written, formal summary report. • Respond to and/or attend hearings as required which may include some travel.