Overview Spine Surgeon Telecommute Medical Review
Location: US-NJ-Newark. This telecommute role provides the ability to customize your schedule and caseload within a Monday - Friday work week and business hours. Compensation is per case as a 1099 independent contractor. Candidates must have a NJ license.
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, performance standards, 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.
Meet with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues (as required).
Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
Return cases in a timely manner with clear, concise, and complete rationales and documented criteria.
Telephonically contact providers and interact with other health professionals in a professional manner; discuss disclaimers and appeal process with providers.
Attend orientation and training; perform other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
Identify, critique, and utilize current criteria and resources (national, state, professional guidelines, peer‑reviewed literature) to support sound decision making in reviews.
Provide copies of any criteria utilized in a review to a requesting provider in a timely manner.
Qualifications
Education/Credentials
Board certified MD, DO; understanding of network services, managed care, appropriate utilization of services and credentialing, quality assurance, and policy development.
Current, unrestricted clinical license(s) (or process in place if license is restricted).
Board certification by American Board of Medical Specialties or American Board of Osteopathic Specialties required 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; ability to perform review services.
Ability to work with regulatory agencies, carriers, employers, nurses, and other health professionals.
Medical direction should avoid conflicts of interest.
Evidence of current error and omissions liability coverage.
Managed care orientation; knowledge of current practice standards in the specialty.
Good negotiation and communication skills.
Working Conditions/Physical Demands
Phone access and computer access to complete reviews; ability to prepare reports within timeframes.
Telephonic conferences; access to confidential information requiring discretion and secure information management.
This position is an independent contractor role for Concentra.
Concentra is an Equal Opportunity Employer M/F/Disability/Veteran. Concentra's Data Protection Commitment applies to handling patient data and protecting privacy.
Additional Information
This role is part of the medical review stream; the information above reflects the responsibilities and qualifications as described in the job posting.