Nurse Practitioner/Physician Assistant/Nurse Medical Services Consultant

We're consultants. We're motivators. We're educators. We're Affiliated Computer Services, Inc. (ACS), a premier provider of diversified business process and information technology outsourcing solutions to commercial and government clients worldwide. We are a FORTUNE 500 company comprised of more than 47,000 people in multiple locations around the world. ACS. We're leaders. We're thinkers. We're inventors. We're doers.

The Medical Services Consultant is an intermediate level professional who possesses and applies a broad knowledge of pharmacy, dental and medical program(s), policy, process and administration. Incumbents apply a strong knowledge of concepts to tasks and activities that are complex in nature and perform a full range of analytical and/or professional activities. The incumbent generally works under difficult deadlines and frequently handles heavy workloads, operating with minimal oversight and only general goals being set.

REPRESENTATIVE PRINCIPAL DUTIES AND RESPONSIBILITIES*

Provides professional and analytical support focusing on the analysis, program development and evaluation of applicable medical services offerings (including medical, dental and pharmaceutical).

Analyzes existing medical, dental and pharmacy plans to ensure performance measures are being met; makes recommendations on methods for improvement.

Develops applicable utilization reports focusing on pharmaceutical, dental and medical plan usage; provides analyses and recommendations based on findings.

Provides professional/analytical support to applicable medical services programs including implementation, operation and contract compliance (e.g. Medicare/Medicaid program).

Consults with applicable industry resources, regulatory authorities and health plan administrators to ensure the development and maintenance of applicable medical services guidelines.

Monitors and reports on industry developments which may impact applicable medical services offerings including legislative/legal developments at the local, state and federal level.

Stays abreast of developments in field of expertise to ensure knowledge base remains current.
Education and Typical Years of Experience Bachelor’s degree in health care/medical field required; applicable medical certifications/licenses required (e.g., R.Ph).

5+ years of health care/medical industry experience required at a professional/management level.
 Special Requirements Responsibilities include analyze medical/procedure (e.g., radiology, rehab, home health, etc.) utilization trends, identify services/procedures for prior authorization, and apply evidence-based principles to prior authorization criteria development. The successful candidate will also serve as a clinical consultant to ACS Heritage and its clients. Experience with utilization/quality management and a working knowledge of coding (e.g., ICD-9, CPT, and HCPCS) are preferred. Word processing/spreadsheet/flowchart management software (e.g., MS Word/Excel/Visio) experience desired. Part-time or full-time opportunity available.  Benefits 

Dental Insurance Flexible Benefits Health Insurance Holidays Life Insurance 401K / Retirement Plan Sick Leave Vacation Vision Insurance

 

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