Opportunity Overview
The Vermont Medicaid Physician Review and Consulting Services procurement, RFP 03410-245-27, is issued by the Department of Vermont Health Access (DVHA). The State seeks actively licensed physicians to provide medical oversight, prior-authorization case review, medical-necessity determinations and related clinical consulting in Vermont’s Medicaid managed-care environment.
Deadline and Current Status
The controlling RFP states that this RFP will remain open until filled. Questions and State responses are ongoing. The Vermont Business Registry displays July 10, 2027 at 2:00 PM as an administrative close date, but Atlas does not treat that registry shell date as the controlling hard deadline because the current RFP expressly states that responses remain open until filled.
Scope of Work
Responsibilities include reviewing prior-authorization requests for medical necessity, helping the Clinical Services Team interpret submitted clinical information, supporting review and adoption of clinical guidelines, reviewing non-emergent medical transportation for medical necessity, assisting Vermont Chronic Care Initiative nurse case managers, participating in monthly case reviews, conducting peer-to-peer discussions with requesting providers, participating in appeals and fair hearings, and supporting quality-improvement activities.
Time Commitment and Contract Term
Each contractor provides consultative services on an as-needed basis, generally not to exceed ten hours per week under a mutually agreed schedule. The State may consider and award bids from multiple physicians totaling up to 16 hours per week. Contracts are for three years with an option to renew for up to two additional years.
Mandatory Qualifications
Qualified candidates must possess an M.D. or D.O. and an active Vermont medical license in good standing. The RFP requires Vermont Medicaid credentialing standards and identifies expertise in care management and quality improvement, understanding of national and Vermont health reform, experience treating acute and complex medical needs including co-occurring substance use, mental health and medical conditions, familiarity with electronic health records, strong process-improvement and communication skills, and advanced clinical-data analysis capability. Board certification in an ABMS-approved specialty is preferred, as is broad primary care/general internal medicine experience or prior medical-necessity review experience.
Contracting, Pricing and Compliance
The project is funded in whole or in part with federal monies. Compensation is negotiable and commensurate with experience; no contract ceiling or guaranteed value is published. Selected bidders must execute the State’s standard contract and applicable attachments. The controlling packet also requires the bidder to satisfy the applicable Vermont contracting, insurance, business-registration, tax, privacy/security and business-associate requirements. Atlas must verify all required references, insurance evidence, W-9 and other bidder-controlled documents before submission and must never fabricate them.
N9+ and QC Healthcare Analysis
Atlas Opportunity Score: 88/100. This is a strong, ongoing direct clinical-services procurement with a clear physician scope and recurring multi-year consulting potential, but bidder readiness depends on specific Vermont licensure, Medicaid credentialing and documented experience.
N9+ Fit: 0/100. The Nonagon N9+ remote physical examination platform is not part of the solicited scope. Atlas should not force an N9+ proposition into utilization review, medical-necessity determination or physician consulting work.
QC Healthcare Fit: 90/100, conditional. The clinical-review and physician-consulting scope is strongly aligned with QC Healthcare services if a named M.D./D.O. can be verified with an active Vermont medical license in good standing, Vermont Medicaid credentialing and the required care-management, quality-improvement and complex-care experience.
Direct Vendor Review
This is a strong conditional Dr. Miltie/QC Healthcare direct-vendor opportunity. Do not advance a TRUE direct submission until the named physician, Vermont license, Medicaid credentialing, comparable references, insurance, W-9, applicable Vermont business registration, State contract/BAA compliance and all other bidder-controlled requirements are verified from legitimate records.
Next Action
Complete a documented bidder-qualification matrix against the live RFP and all addenda, identify the qualifying Vermont-licensed physician or physicians, validate Medicaid credentialing and required references/insurance/registration documents, and prepare a compliant technical and pricing response only after those gates are satisfied.
State contact: Emily Weidman, AHS.DVHAGrantsContracts@vermont.gov, 802-879-5900.
Official sources: Vermont Business Registry Bid Detail and the attached RFP 03410-245-27.