Physician - Centralized Eligibility & Appeals Team (CEAT)

Full Job Description

The VISN CEAT is assigned to an interprofessional team to perform Program of Comprehensive Assistance for Family Caregivers (PCAFC) eligibility determinations and appeal adjudications, respectively, within the CEAT program.

To qualify for this position, you must meet the basic requirements as well as any additional requirements (if applicable) listed in the job announcement.

Applicants pending the completion of training or license requirements may be referred and tentatively selected but may not be hired until all requirements are met.

Currently employed physician(s) in VA who met the requirements for appointment under the previous qualification standard at the time of their initial appointment are deemed to have met the basic requirements of the occupation.

Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.

Degree of doctor of medicine or an equivalent degree resulting from a course of education in medicine or osteopathic medicine.

The degree must have been obtained from one of the schools approved by the Department of Veterans Affairs for the year in which the course of study was completed.

Current, full and unrestricted license to practice medicine or surgery in a State, Territory, or Commonwealth of the United States, or in the District of Columbia.

Residency Training: Physicians must have completed residency training, approved by the Secretary of Veterans Affairs in an accredited core specialty training program leading to eligibility for board certification.

(NOTE: VA physicians involved in academic training programs may be required to be board certified for faculty status.) Approved residencies are: (1) Those approved by the Accreditation Council for Graduate Medical Education (ACGME), b) OR [(2) Those approved by the American Osteopathic Association (AOA),OR (3) Other residencies (non-US residency training programs followed by a minimum of five years of verified practice in the United States), which the local Medical Staff Executive Committee deems to have provided the applicant with appropriate professional training and believes has exposed the physician to an appropriate range of patient care experiences.

Residents currently enrolled in ACGME/AOA accredited residency training programs and who would otherwise meet the basic requirements for appointment are eligible to be appointed as "Physician Resident Providers" (PRPs).

PRPs must be fully licensed physicians (i.e., not a training license) and may only be appointed on an intermittent or fee-basis.

PRPs are not considered independent practitioners and will not be privileged; rather, they are to have a "scope of practice" that allows them to perform certain restricted duties under supervision.

Additionally, surgery residents in gap years may also be appointed as PRPs. Proficiency in spoken and written English.

Preferred Experience: Primary Care, PM&R or Geriatric experience for 5 or more years Knowledge/experience with VA Caregiver Support Program Experience with clinical reviews Experience with interdisciplinary collaboration and decision-making Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/.

Physical Requirements: The physical demands of this position involve primarily walking, talking, driving, use of the telephone and computer , etc.

Strenuous physical activity is not required although the incumbent is expected to withstand pressure and stress as part of their daily activities. Light lifting and carrying - under 15 pounds.

Hearing aid permitted as needed. Major Duties:

VA offers a comprehensive total rewards package. VHA Physician Total Rewards.

Duty Location: Workstation to be assigned upon selection to one of the pre-identified VISNs Work Schedule: Compressed tour may be offered Pay: Competitive salary, annual performance bonus, regular salary increases Paid Time Off: 50-55 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year and possible 5 day paid absence for CME) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory CME: Possible $1,000 per year reimbursement (must be full-time with board certification) Malpractice: Free liability protection with tail coverage provided Contract: No Physician Employment Contract and no significant restriction on moonlighting The VISN CEAT Physician reports to the VISN CEAT Lead Physician, who aligns directly under the VISN Chief Medical Officer.

The incumbent is assigned to an interprofessional team to perform PCAFC eligibility determinations and appeal adjudications, respectively, within the CEAT program.

The incumbent will also perform clinical duties, outside the scope of the VISN CEAT, respective of his/her Credentials and Privileges within the VISN.

Responsibilities: Adjudicating appeals at the VISN/WSNC/National level.

Review of Veteran's medical record summary, most recent History & Physical, findings of recent testing at the facility, caregiver assessment and care team input.

Understand eligibility associated with VA service connection and conducts review of eligibility documents, as needed, to determine whether service-connected condition meets eligibility requirement.

Knowledge of PCAFC clinical eligibility to coordinate with other regional CEATs in the transfer of appeals for inter-VISN evaluation.

Analyze data obtained in record review for use in determining clinical eligibility for PCAFC. Document information utilized in clinical eligibility determination and eligibility assessment tools.

Additional duties as assigned.