Dentist Telecommute Medical Review Stream

Concentra Careers; Newark (NJ); Remote; USD 150,000 - 200,000; Part time

Job summary

A national healthcare provider is seeking a Board Certified Dentist for an independent contractor role to review health claims and provide clinical interpretations. This position allows for flexible scheduling from home, involving direct patient care experience and compliance with healthcare standards. Candidates must be current in their practice with a valid NJ license and have proven telephonic skills.

Benefits

Flexible work schedule

Compensation on a per-case basis

Qualifications

• Strong understanding of network services, managed care, and utilization management.
• Must be actively practicing medicine to perform appeals.
• Evidence of current error and omissions liability coverage.

Responsibilities

• Review medical files and recommend utilization review.
• Maintain proper credentialing, licenses, and certifications.
• Communicate with providers and health professionals.

Skills

Proven computer and telephonic skills

Experience performing review services

Strong negotiation and communication skills

Education

Board-certified MD or DO

Current, unrestricted clinical licenses

Job description

Overview

Are you an accomplished Board Certified Dentist? Candidates must have a NJ license.

Are you passionate about work/life balance? We are seeking flexible and experienced physicians for our medical review stream division. This telecommute role allows you to customize your schedule and caseload within a Monday - Friday work week and during business hours. Create a flexible work schedule and be compensated on a per-case basis as a 1099 independent contractor.

Job Summary:

Relying on your clinical background, you will review health claims, providing medical interpretation and decisions regarding the appropriateness of services provided by healthcare professionals, in compliance with Concentra Physician Review policies, procedures, performance standards, URAAC guidelines, and state regulations.

Responsibilities:

• Review medical files and recommend utilization review, chart reviews, medical necessity, appropriateness of care, return to work, disability claims, FMLA, and workers' compensation claims.
• Meet with the Concentra Physician Review Medical Director as required to discuss quality of care, credentialing, and licensure issues.
• Maintain proper credentialing, licenses, and certifications necessary for the role.
• Return cases promptly with clear, concise, and complete rationales and documented criteria.
• Communicate telephonically with providers and other health professionals professionally, discussing disclaimers and appeal processes.
• Attend orientation and training sessions.
• Perform additional duties as assigned, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.
• Utilize current criteria and resources such as national, state, and professional guidelines and peer-reviewed literature to support objective decision-making.
• Provide copies of utilized criteria to requesting providers in a timely manner.

Qualifications:

Education / Credentials:

• Board-certified MD or DO with a strong understanding of network services, managed care, utilization management, credentialing, and quality assurance.
• Current, unrestricted clinical licenses (or with processes to ensure compliance if restricted).
• Board certification by the American Board of Medical Specialties or Osteopathic Specialties is required for MD or DO reviewers.
• Must be actively practicing medicine to perform appeals.

Job-Related Experience:

Post-graduate experience in direct patient care.

Job-Related Skills / Competencies:

• Proven computer and telephonic skills.
• Experience performing review services.
• Ability to collaborate with regulatory agencies, carriers, employers, nurses, and healthcare professionals.
• Medical direction should be provided without conflicts of interest.
• Evidence of current error and omissions liability coverage.
• Managed care orientation and knowledge of current specialty standards.
• Strong negotiation and communication skills.

Working Conditions / Physical Demands:

• Phone accessibility.
• Access to a computer for reviews.
• Ability to complete cases with typed reports within specified timeframes.
• Participation in telephonic conferences.

This role involves handling confidential and sensitive information, requiring discretion and secure data management.

Concentra is an Equal Opportunity Employer / F / Disability / Veteran

Concentra's Data Protection Commitment:

• Committed to protecting patient data and privacy.
• All colleagues must adhere to data protection principles.
• Role-specific policies apply for handling sensitive data.

This position is an independent contractor role for Concentra.

Concentra is an Equal Opportunity Employer, including for disability and veterans.