Medical Consultant Services

The vendor is required to provide to review and provide medical opinions on clinical practice, emerging patterns of practice, professional standards, and patient records, including circumstances described in legislation, such as appropriateness of visits or health services claimed to the plan.
- Supporting decision-making and oversight:
• Review and provide opinions on physician claims and their alignment with legislation, professional standards and medical practice.
• Provide expert advice to support agency policy development and compliance activities.
• Deliver insights to improve compliance related evaluations and outcomes.
• Review and provide support interpreting physician feedback in response to findings determined during compliance reviews.
- Provide feedback as required on determinations made by clinical advisors, review patient records to assess and confirm alignment with the schedule, medical requirement, frequency of services, confirm or identify issues related to patient safety, prescribing and care plan.
- The province requires the medical consultant be accessible during regular business hours, Monday through Friday except statutory holidays.
- Timing and time-related constraints will be managed by unit management.
- Contract Period/Term: 2 years