Telecommute Medical Review Specialist
4 weeks ago
Concentra is seeking a skilled Neurologist to join our medical review team as a Telecommute Medical Review Specialist. In this role, you will review health claims and provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals.
As a Telecommute Medical Review Specialist, you will work independently to 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.
You will also be responsible for maintaining proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
Key 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.
- 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.
- Discusses the appropriate disclaimers and appeal process with the providers.
Requirements:
- 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.
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.
Concentra is an Equal Opportunity Employer, including disability/veterans.
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