Hematologist

Maximus; United States; Remote; USD 165,000 - 248,000; Full time

Benefits offered by this job

Remote work

1099 contract

Job summary

A healthcare consulting firm seeks a 100% Remote Hematology Oncology MD/DO Reviewer to conduct medical expert reviews on treatment coverage for the CA DMHC. Candidates should have at least five years of experience in their specialty and a minimum of 24 hours of direct patient care per week. Responsibilities include assessing medical necessity and determining whether treatments are experimental or investigational. This position offers the flexibility to work on a schedule that fits your needs, with training provided for the initial cases.

Qualifications

• 5 years’ experience in appropriate specialty post training.
• 24 hours of direct patient care per week.

Responsibilities

• Conduct medical expert reviews on treatment coverage.
• Make final decisions based on treatment necessity and investigational status.
• Participate in review training for initial cases.
• Work as a specialty-driven expert within the requested specialty.

Skills

Medical Expert Review

Patient care

Specialty expertise

Medical necessity assessment

Tools

Web-based portal

Templates

Review Training

Job description

We are looking for a 100% Remote, 1099, Hematology Oncology MD/DO Reviewer

Description

• Medical Expert Reviewer-Medical Expert Judgement Reviews determining final decision based off enrollee’s denial of treatment coverage denied by the CA DMHC.
• Reviews are based off Medical Necessity and Experimental/Investigational.
• Specialty Driven-Expert within the Specialty Requested.

This service involves getting a thorough and professional medical review from an expert provider. The review is done to make a final decision on whether a particular treatment should be covered by the CA DMHC (Department of Managed Health Care) or not. The reviews are based on two main factors: medical necessity (whether the treatment is necessary for the patient's health) and whether the treatment is experimental or investigational.

Systems and Tools

• Expert Reviewers must use their own personal computer to access a web-based portal.
• Review Training –Trainer will work closely with reviewer for the first 3-5 cases.
• Scheduled Training- based on reviewer’s schedule.
• No direct defined evidence standard or guidelines.
• Templates will be used to complete reviews.

Provider Specialty

Minimum Qualifications

• 24 hours of direct patient care per week.
• 5 years’ experience in appropriate specialty post training.

Medical Necessity Review: Standard Case

Most common type of review.

30 – 45 minutes to complete.

5 – 7 days to turnaround.

Medical Necessity Review: Expedited Case

Sickest patients 24-hour turnaround.

45 min - 1 hour to complete.

Experimental/Investigational Reviews: Standard Case

Second most common review.

1-2 hours to complete (based on experience).

5 - 7-day turnaround.

Volume: Varies based on need.

Experimental/Investigational Reviews: Expedited Case

Sickest of patients 24-hour turnaround.

1-2 hours to complete (based on experience).

For more information about Maximus, please visit https://maximus.com/ to learn more about our organization.