Overview
Are you an accomplished Board Certified physician in one of the below specialties? Preferred candidates will have a TX license.
General Surgery
Neurologist
Orthopedic Surgery with hand or spine specialty
Physical Medicine & Rehabilitation
Plastic Surgery
Podiatrist
Pain Medicine
Neurosurgeon
Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical review stream division. This telecommute role provides the ability to customize your schedule and caseload within a Monday - Friday work week and within business hours. Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor.
JOB SUMMARY: Relying on clinical background, reviews health claims, providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations.
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, FMLA, group health and workers' compensation claims.
Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care, credentialing, and state licensure issues.
Maintain 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 disclaimers and appeal process with 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 (national, state, and professional guidelines and peer-reviewed literature) to support sound decision making and rationales in reviews.
Provides copies of any criteria utilized in a review to a requesting provider in a timely manner.
Qualifications
Education/Credentials:
Board certified MD, DO, with understanding of network services and managed care, utilization of services, credentialing, quality assurance, and policy development.
Current, unrestricted clinical license(s) (or process to ensure functions do not violate restrictions).
Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties for MD or DO reviewer.
Must be in active medical practice to perform appeals.
Job-Related Experience: Post-graduate experience in direct patient care.
Job-Related Skills/Competencies:
Demonstrated computer and telephonic skills and ability to perform review services.
Ability to work with regulatory agencies, carriers, employers, nurses, and healthcare professionals.
Medical direction must be provided without financial conflict of interest.
Evidence of current error and omissions liability coverage.
Managed care orientation; knowledge of current practice standards in specialty.
Good negotiation and communication skills.
Working conditions include phone access, computer for reviews, ability to complete cases with typed reports within timeframes, and 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 protecting patient data and ensuring 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.
Additional Data
This position is an independent contractor role for Concentra.
Concentra is an Equal Opportunity Employer, including disability/veterans