Medicaid Utilization Review and Physician Consulting Services
Vermont > Agency of Human Services > Department for Children and Families
Original Solicitation Links
03410-245-27
]Medicaid Physician Review and Consulting Services
03410-245-27
]Medicaid Physician Review and Consulting Services
Contact
Submission Instructions
Description
The State of Vermont, through the Agency of Human Services and Department of Vermont Health Access, is seeking proposals from actively licensed physicians to provide medical oversight, prior authorization case review, utilization review, and medical necessity determinations in a Medicaid managed care environment. Responsibilities include reviewing requests for medical services, applying evidence-based literature, accepted standards of care, Vermont Medicaid criteria, and national guidelines; supporting clinical guideline development; reviewing non-emergent medical transportation; assisting nurse case managers; participating in case reviews, appeals, fair hearings, quality improvement activities, and provider peer-to-peer discussions; and preparing written medical opinions within five business days of receiving assigned requests. The contractor must hold an M.D. or D.O. degree, maintain an active Vermont medical license, meet Vermont Medicaid credentialing standards, and possess relevant clinical, utilization review, care management, quality improvement, analytical, and communication expertise. Services are provided as needed for up to 10 hours per week per contractor, with the State able to award multiple contracts totaling up to 16 hours per week. The contract is for three years with options to renew for two additional years. Responses must include a cover letter, technical response, references, price schedule, and signed Certificate of Compliance, submitted electronically by email as a single message with searchable PDF attachments.
Classification Codes
Smart Codes
Specifications
Timeline
Requirements
- Medical Malpractice — $1,000,000.00
- Professional Liability
- Minimum 3 references
- Within the last 1 year
- Client point of contact required for each reference
Location
Documents
| Title | Date Posted |
|---|---|
| rfp071326f | Jul 13, 2026 09:04 AM |
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