Join to apply for the Spine Medical Review Stream Physician role at Concentra
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Join to apply for the Spine Medical Review Stream Physician role at Concentra
Overview
Are you an accomplished
General Surgery
Orthopedic Surgery with hand or spine specialty
Physical Medicine & Rehabilitation
Plastic Surgery
Podiatrist
Overview
Are you a Board Certified physician in one of the below specialties? Preferred candidates will have a LA license.
General Surgery
Neurologist
Orthopedic Surgery with hand or spine specialty
Physical Medicine & Rehabilitation
Plastic Surgery
Podiatrist
Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical review stream division. This telecommute role offers you the flexibility to customize your schedule and caseload within a Monday - Friday work week and during business hours. You will be compensated on a per case basis as a 1099 independent contractor.
Job Summary
Based on your clinical background, you will review health claims, providing medical interpretation and decisions regarding the appropriateness of services provided by other healthcare professionals, in compliance with Concentra Physician Review policies, procedures, and standards, as well as URAAC guidelines and state regulations.
Responsibilities
Major duties include:
Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, and appropriateness of care, including return to work, disability, FMLA, and insurance claims.
Meet with Concentra Physician Review Medical Director as required to discuss quality of care and licensing issues.
Maintain proper credentialing and licenses, including any certifications necessary.
Return cases promptly with clear rationales and documented criteria.
Communicate professionally with providers via phone, discussing disclaimers and appeal processes.
Attend orientation and training sessions.
Perform additional duties, including responding to quality assurance issues, complaints, and regulatory audits.
Utilize current guidelines and literature to support objective decision-making.
Provide criteria used in reviews to requesting providers in a timely manner.
Qualifications
Board-certified MD or DO with an understanding of network services, managed care, utilization, and credentialing.
Current, unrestricted clinical license(s); if restricted, ensure job functions do not violate restrictions.
Board certification by ABMS or AOBOS is required for MD or DO reviewers.
Active medical practice experience is necessary to perform appeals.
Experience & Skills
Post-graduate experience in direct patient care.
Proficiency in computer and telephonic communication.
Ability to perform review services and collaborate with various healthcare professionals.
Must have current error and omissions liability insurance.
Knowledge of managed care and current specialty standards.
Strong negotiation and communication skills.
Working Conditions
Access to a phone and computer.
Ability to complete reviews and reports within specified timeframes.
Participation in telephonic conferences.
This role involves handling confidential information, requiring discretion and secure data management.
Concentra is an Equal Opportunity Employer M/F/Disability/Veteran.
Concentra's Data Protection Commitment includes safeguarding patient data and adhering to privacy principles. Role-specific policies apply for those handling sensitive information.
This position is an independent contractor role.
Concentra is an Equal Opportunity Employer, including for disability and veterans.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Sales and Business Development
Industries
Hospitals and Health Care
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