Neurologist Telecommute Medical Review Stream Physician

Concentra, Inc.; Newark (NJ); Remote; USD 150,000 - 250,000; Full time

Job summary

An established industry player is seeking an accomplished Board Certified Neurosurgeon for a flexible telecommute role. This independent contractor position allows you to customize your schedule while providing critical medical reviews of health claims. You will leverage your clinical expertise to ensure compliance with policies and guidelines, while maintaining high standards of care. Join a dynamic team where your contributions will directly impact patient outcomes and the quality of healthcare services. If you are passionate about work/life balance and making a difference, this opportunity is perfect for you.

Qualifications

• Board certified MD or DO with a strong understanding of managed care.
• Active medical practice experience necessary for performing appeals.

Responsibilities

• Reviews medical files and provides recommendations for utilization review.
• Maintains proper credentialing and licenses, including special certifications.
• Contacts providers and interacts professionally with health professionals.

Skills

Computer Skills

Telephonic Skills

Negotiation Skills

Communication Skills

Managed Care Orientation

Education

Board Certified MD or DO

Current Clinical License

Board Certification by American Board

Job description

Overview

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

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

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, and performance standards, URAAC guidelines, and state regulations.

Responsibilities

MAJOR DUTIES AND RESPONSIBILITIES:

1. 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.
2. Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care, credentialing, and licensure issues.
3. Maintain proper credentialing and licenses, including any special certifications necessary to perform the job.
4. Returns cases in a timely manner with clear, concise, and complete rationales and documented criteria.
5. Contacts providers telephonically and interacts professionally with other health professionals, discussing disclaimers and the appeal process.
6. Attends orientation and training sessions.
7. Performs additional duties as assigned, including addressing quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
8. Utilizes current criteria and resources such as national, state, and professional guidelines, peer-reviewed literature to support objective decision-making.
9. Provides copies of utilized criteria to requesting providers promptly.

Qualifications

EDUCATION/CREDENTIALS:

• Board certified MD or DO with a strong understanding of network services, managed care, utilization of services, credentialing, and quality assurance.
• Current, unrestricted clinical license(s) (or with processes in place for restricted licenses).
• Board certification by the American Board of Medical Specialties or the American Board of Osteopathic Specialties.
• Active medical practice experience necessary for performing appeals.

JOB-RELATED EXPERIENCE:

• Post-graduate experience in direct patient care.

JOB-RELATED SKILLS/COMPETENCIES:

• Strong computer and telephonic skills.
• Ability to perform review services effectively.
• Experience working with regulatory agencies, carriers, employers, nurses, and healthcare professionals.
• Knowledge of current practice standards in specialty areas.
• Good negotiation and communication skills.
• Must have current error and omissions liability coverage.
• Managed care orientation.

Working Conditions/Physical Demands

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

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

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

Concentra's Data Protection Commitment: Concentra is committed to protecting patient data and ensuring privacy. All colleagues handling sensitive data must adhere to data protection policies.

Additional Data

This position is an independent contractor role for Concentra.

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