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Medical Review Specialist
1 month ago
We are seeking a skilled and experienced physician to join our medical review team as an independent contractor. As a Medical Review Specialist, you will be responsible for reviewing health claims and providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals.
Responsibilities- Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers' compensation claims.
- Meet with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
- Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
- Return cases in a timely manner with clear concise and complete rationales and documented criteria.
- Telephonically contact providers and interact with other health professionals in a professional manner.
- Attend orientation and training.
- Perform other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
- Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
- Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board);
- Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
- Must be in active medical practice to perform appeals.
- Phone accessibility.
- Access to a computer to complete reviews.
- Ability to complete cases accompanied by a typed report in specified time frames.
- Telephonic conferences.
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Concentra is an Equal Opportunity Employer M/F/Disability/Veteran.
