Medical Expert

C2 ALASKA, LLC

Remote

The Medical Expert shall provide meaningful, prompt, reliable case evaluation and written responses, that are policy-compliant, accurate, relevant, sufficient, and current.

• Respond to written medical interrogatories or “Requests for Medical Comment” from the Appeals Council to provide an impartial medical expert opinion at the Appeals Council level.
• Conduct an in-depth review of the relevant portions of the medical claims file or other evidence provided by OAO in a manner consistent with the performance expectations in Section B-6.
• Shall respond to written medical interrogatories or “Requests for Medical Comment” from the Appeals Council regarding medical/psychological issues in a case.
• Shall be familiar with and able to reference the applicable Social Security regulations, including the Listing of Impairments, and other relevant SSA guidance in considering claims of disability.
• Results of all written service requests shall be submitted on predetermined templates and/or in specific formats to assist the adjudicators making a determination.
• Receive, open, and navigate electronic folders
• Fully complete case study review and understand the medical evidence in the record prior to providing a written response.
• Answer all questions completely, including providing references to specific medical findings, exhibit numbers when appropriate, and other evidence received from OAO.
• Have a working understanding of the concepts and regulations that the adjudicator will consider when determining disability. For example, but not limited to:
  • What a medically determinable impairment is, and SSA’s definitions for

symptoms, signs, and laboratory findings.

• SSA’s requirement to consider the combined effects of impairments.
• SSA’s Listing of Impairments (commonly referred to as the “listing”’)
• SSA’s definitions of “meeting” and “medically equaling” specific listings.

The Medical Expert should be prepared to cite specific listings that may apply to the

claimant, and the specific evidence to support whether a claimant meets or

medically equals the listing(s).

• The concept of residual functional capacity (RFC) for all cases except SSI

child cases, including the types of evidence and kinds of physical and

mental work-related limitations SSA considers in assessing RFC.

• In cases involving SSI claimants under age 18, the area(s) of pediatric

medicine appropriate to the claim, typical child development and

functioning, and SSA’s policy of “functionally equaling” the listing.

• SSA’s concept of “duration” of disability

• Provide a medical opinion regarding what the claimant can still do

despite his or her impairments and whether the claimant has one or more

impairment-related limitations or restrictions in the following abilities:

• The ability to perform physical demands of work activities, such as sitting,

standing, walking, lifting, carrying, pushing, pulling, or other physical

functions (including manipulative or postural functions, such as reaching,

handling, stooping, or crouching),

• The ability to perform mental demands of work activities, such as

understanding; remembering; maintaining concentration, persistence, or

pace; carrying out instructions; or responding appropriately to supervision,

co-workers, or work pressures in a work setting,

• The ability to perform other demands of work, such as seeing, hearing, or

using other senses, and

• The ability to adapt to environmental conditions, such as temperature

extremes or fumes.

• Revise or clarify any responses that OAO believes is not policy-compliant or is insufficient, when the AC directs the Medical Expert to do
• Other duties as assigned

• • Doctorate of Medicine from an accredited college approved by the Council of Medical Education and Hospitals of the American Medical Association from a college accredited by the specialized field.
  • Completion of a residency and/or fellowship in specialty
  • Possess and maintain a Valid unrestricted license to practice medicine within one of the 50 states, the District of Columbia, Puerto Rico, or the U.S. Virgin Islands
  • Minimum one (1) year experience practicing in specialty.

  OR

  • Doctor of Philosophy (Ph.D.) or (Psy.D.) degree in clinical or counseling psychology from an APA-accredited psychology program.
  • Completion of an APA-approved clinical psychology internship
  • Possess and maintain a Valid unrestricted license to practice medicine within one of the 50 states, the District of Columbia, Puerto Rico, or the U.S. Virgin Islands
  • Minimum of three (3) years of clinical experience within the last seven (7) years
  • Minimum two (2) years of supervised clinical experience as a psychologist in health service, at least one (1) year of which is post master’s degree.

   

  Preferred Qualifications:

  • N/A

   

  Knowledge, Skills and Abilities:

  • Ability to read, write, and speak English well enough to effectively communicate with all parties and other health care providers. In addition, if the position requires the use of computers, the contract HCPs shall be computer-literate.
  • Knowledge of the required education, training, experience, and documented current competence in the required specialty position description.
  • Possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to a variety of patients from diverse backgrounds.
  • Ability to write in a clear, concise, grammatically correct manner.
  • Knowledge and excellent computer skills include the use of computer software applications for drafting documents, data management, and tracking. This includes competency with Microsoft Office (Word, Excel, Outlook, PowerPoint).

   

  Physical Demands: (The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.)

  • While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee may use repeated motions that include the arms, wrists, hands and/or fingers. The employee is occasionally required to walk, stand, climb, balance, stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.