Position Title: Medical Consultant / Disability Medical Consultant

Position Title: Medical Consultant / Disability Medical Consultant
Client: Indiana Family and Social Services Administration (FSSA) – Disability Determination Bureau (DDB)
Contract: RFP 26-87343 – Medical Consultation Services

Primary Responsibilities

• Review and evaluate medical evidence and case files associated with Social Security Disability claims.
• Provide medical consultation and professional medical opinions to the DDB.
• Apply medical knowledge, training, and experience in accordance with the Social Security Administration (SSA) Program Operations Manual for the Evaluation of Social Security Disability Claims.
• Review cases involving all adult and child body systems, except mental/behavioral health.
• Complete assigned cases and return them to the DDB workflow within 48 hours of receipt.
• Maintain a minimum 95% accuracy rate, as measured through Social Security Administration Disability Quality Branch (DQB) reviews.
• Correct deficient work products at no additional cost when the work does not meet SSA standards or internal quality requirements.
• Complete required time/activity reports and other reports requested by the State.
• Attend or review training provided by SSA/DDB and, when agreed upon, provide training to State personnel.
• Respond to DDB communications within 48 hours.
• Maintain confidentiality and comply with HIPAA, HITECH, and applicable State/Federal privacy requirements when handling PHI/PII.
• Disclose potential conflicts of interest and maintain impartiality in disability case evaluations.

Mandatory Candidate Requirement

The most important qualification explicitly stated in the Scope of Work is:

The candidate must maintain an unrestricted and non-probationary medical license issued by the State of Indiana.

Work Arrangement

The consultant may work:

• At the Indiana DDB office  or
• At a State/SSA-approved remote location, subject to SSA approval.
• Remote reviews must use SSA-provided equipment and secured VPN.
• The consultant must be willing to report to the DDB office with minimal notice when required.

The work is not full-time, and the consultant is allowed to provide services to other organizations, subject to the conflict-of-interest requirements.

Required

• MD or DO / qualified physician.
• Current unrestricted, non-probationary Indiana medical license.
• Experience reviewing medical records and making clinical/medical determinations.
• Ability to evaluate medical evidence across adult and pediatric body systems.
• Ability to interpret medical documentation and determine functional/medical implications relevant to disability claims.
• Strong written clinical documentation skills.
• Ability to complete cases within 48 hours.
• Ability to maintain 95%+ accuracy.
• Ability to work independently and meet DDB workflow requirements.
• Ability to comply with SSA disability-program requirements.
• Ability to maintain strict confidentiality when handling PHI/PII.

Strongly Preferred

• Previous experience with Social Security Disability/SSA/DDS/DDB case review.
• Experience as a medical consultant, disability determination consultant, utilization reviewer, independent medical reviewer, or similar role.
• Experience reviewing both adult and pediatric cases.
• Familiarity with SSA''''s disability evaluation framework/POMS.
• Experience with medical chart review and clinical documentation.