Hematologist

Maximus; United States; Remote; USD 150,000 - 200,000; Full time

Job summary

A leading healthcare services provider is seeking a 100% Remote Hematology Oncology MD/DO Reviewer. Responsibilities include conducting thorough medical reviews to determine treatment coverage eligibility based on medical necessity and investigational status. Candidates must hold an MD or DO in Hematology Oncology with a minimum of 5 years of experience, providing 24 hours of direct patient care per week. Join us to make impactful healthcare decisions from the comfort of your own home.

Qualifications

• Minimum 5 years of post-training experience in Hematology Oncology.
• Must provide 24 hours of direct patient care per week.

Responsibilities

• Conduct thorough medical reviews for treatment coverage.
• Determine if treatments are experimental or medically necessary.
• Participate in training and follow scheduled review processes.
• Engage in training for the first few cases.

Skills

Medical review expertise

Knowledge of medical necessity

Strong communication skills

Attention to detail

Education

MD or DO in Hematology Oncology

Tools

Web-based portal

Job description

Overview

Be among the first 25 applicants. This is a 100% Remote, 1099 Hematology Oncology MD/DO Reviewer position. Direct message the job poster from Maximus.

Job Description: Medical Expert Reviewer for Medical Expert Judgement Reviews determining final decision based on enrollee’s denial of treatment coverage denied by the CA DMHC (Department of Managed Health Care). Reviews are based on Medical Necessity and Experimental/Investigational considerations. Specialty-driven expert within the requested specialty.

Responsibilities

• Provide thorough and professional medical reviews to determine whether a treatment should be covered by CA DMHC.
• Base reviews on medical necessity and whether the treatment is experimental or investigational.
• Serve as a specialty-driven expert within the requested field.
• Access a web-based portal using your own personal computer.
• Participate in review training with the trainer for the first 3–5 cases.
• Follow scheduled training based on the reviewer’s availability.
• Utilize templates to complete reviews.

Systems and Tools

Expert reviewers use a web-based portal accessed from a personal computer.

Minimum Qualifications

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

Review Details

• Medical Necessity Review: Standard Case — most common type; 30–45 minutes to complete; 5–7 day turnaround.
• Medical Necessity Review: Expedited Case — sickest patients; 24-hour turnaround; 45 minutes to 1 hour to complete.
• Experimental/Investigational Reviews: Standard Case — second most common; 1–2 hours to complete with 5–7 day turnaround.
• Experimental/Investigational Reviews: Expedited Case — sickest patients; 24-hour turnaround; 1–2 hours to complete.

About Maximus

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