Telecommute Medical Review Physician
3 weeks ago
We are seeking a highly skilled and experienced Board Certified Internal Medicine physician to join our medical review stream division as a telecommute medical reviewer. This role provides the opportunity to work in a flexible and autonomous environment, with a focus on reviewing health claims and providing medical interpretation and decisions.
Key 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.
- Post-graduate experience in direct patient care.
- Demonstrated computer skills, telephonic skills.
- Demonstrated ability to perform review services.
- Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals.
- Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest.
- Must present evidence of current error and omissions liability coverage for job duties and activities performed.
- Managed care orientation.
- Knowledge of current practice standards in specialty.
- Good negotiation and communication skills.
- Phone accessibility.
- Access to a computer to complete reviews.
- Ability to complete cases accompanied by a typed report in specified time frames.
- Telephonic conferences.
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