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Independent Clinical Reviewer - Medical Necessity

Active

State & Local

Response Deadline10/02/2026, 07:30:00 PM UTC

Contract Overview

Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.

AI Contract Overview

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This subcontract opportunity is for an Independent Clinical Reviewer to support prime contractors on Kentucky Cabinet for Health and Family Services Medicaid projects. The selected professional will be responsible for reviewing medical records and provider submissions to make formal medical necessity determinations for the Department for Medicaid Services based on established clinical guidelines. Qualified candidates must be licensed healthcare professionals, such as MDs, RNs, or other qualified practitioners. The contract is listed under NAICS code 541990, with a response deadline of October 2, 2026.

General Info

Independent Clinical Reviewer for Kentucky Medicaid medical necessity determinations; deadline October 2, 2026.

Agency

Kentucky → Fin - Office of the SecretaryView Agency

NAICS

541990 - All Other Professional, Scientific, and Technical ServicesView NAICS

Place of Performance

Other, KY, USA

Set-Aside

NONE

Documents

This scope was carved out of RFP 746 2700000006.

The full solicitation package (7 documents), including the RFP, is on the prime solicitation, not on this scope.

View the prime solicitation

RFI-758-2700000006-1 | RFI SAS Enterprise Financial Reporting Discovery

AI Contract Breakdown

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No contract breakdown available.

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Timeline

PostedSep 1

subcontract

Response DeadlineOct 2

Submission deadline

Response Deadline

10/02/2026, 07:30:00 PM UTCin 27 days

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Organization & Contact Information

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AgencyKentucky → Fin - Office of the Secretary

ContactsNo contacts available

OfficeN/A

Organization / Agency

Kentucky → Fin - Office of the Secretary

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Office AddressN/A

ContactsNo contact information available

Full Description

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Performs independent clinical reviews for prime contractors on Kentucky Cabinet for Health and Family Services (CHFS) Medicaid projects. Conducts reviews of medical records and provider submissions, applying clinical guidelines to render formal medical necessity determinations for the Department for Medicaid Services (DMS). Requires licensed healthcare professionals (MD, RN, or qualified practitioners). Delivers rendered medical necessity decisions for assigned cases.

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