Pain Medicine Telecommute Medical Review Specialist

4 days ago

Washington, Washington, D.C., United States Concentra Career Choice Full time
Overview

We are seeking a Board Certified Pain Medicine physician to join our medical review stream division as a telecommute medical review specialist. This role offers the flexibility to customize your schedule and caseload within a Monday - Friday work week and within business hours.

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.
  • Discusses the appropriate disclaimers and appeal process with the providers.
  • 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.
  • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
  • Provides copies of any criteria utilized in a review to a requesting provider in a timely manner.
Qualifications
  • 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.

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.

Concentra's Data Protection Commitment

  • Concentra is committed to protect patient data and to ensure privacy of personal and medical information.
  • Every Concentra colleague has the responsibility to adhere to data protection principles.
  • If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

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