Optometrist

Overview

Under the general direction of the Director or designee, the Optometrist has direct responsibility for evaluation of requests for Prior Authorization (PA) of claims for certain visual assistance devices and equipment including but not limited to eyeglasses, custom lenses, certain ophthalmic medications and timely determination of the medical necessity of those requests within Mass Health regulations. The Optometrist shall also make determinations of medical necessity for visual evaluations, replacement of lost or stolen visual aids, repair or replacement of malfunctioning visual aids or other visual assistance requests as required.

They shall also work with Mass Health staff to evaluate emerging products and technologies for consideration of addition to Mass Health coverage.

• Review services for medical necessity identified by relevant Current Procedural Terminology (CPT) codes, provided that review will be determined by relevant Mass Health regulations and deadlines and the Optometrist Manual which shall be controlling.
• Participate and testify as necessary in Fair Hearings of Mass Health concerning appeals resulting from decision of medical necessity of requests for visual services or other matters concerning optometry services.
• Provide staff advice to OCA and Mass Health concerning visual Services including coverage decisions and all relevant visual service matters.
• Be available onsite at OCA offices or elsewhere on a reasonable basis for review of cases, hearings, conferences and presentations as required by OCA.
• Understands the unique challenges and solutions to serve those receiving services in the safety net.
• Perform other duties within professional scope, as required.

• Doctoral degree – Doctor of Optometry (OD)
• 5 years of experience in full scope in optometry and experience in policy, healthcare, or multi settings would be beneficial.
• Experience in the application of State and Federal Medicaid rules and regulations or willingness and ability to become proficient
• Current License with Glaucoma Certification
• Current License with Massachusetts Practice of Optometry

Preferred Qualifications:

• 5 years full scope Optometry