Telecommute Psychiatrist Medical Review Specialist
3 weeks ago
Job Summary:
We are seeking a Board Certified Psychiatrist to join our medical review team in a telecommute capacity. As a Psychiatrist Telecommute Medical Review Specialist, you will review health claims and provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals.
Responsibilities:
- Reviews medical files and provides 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.
- Meets with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
- Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
- Returns cases in a timely manner with clear concise and complete rationales and documented criteria.
- Telephonically contacts providers and interacts with other health professionals in a professional manner.
- Attends orientation and training.
- Performs other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
Qualifications:
- Current, unrestricted clinical license(s);
- 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.
Working Conditions/Physical Demands:
- 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.
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