Orthopedic Surgeon Telecommute Medical Review

Concentra; Jersey City (NJ); Remote; USD 150,000 - 250,000; Full time

Job summary

An established industry player is seeking a Board Certified Orthopedic Surgeon for a telecommute medical review role. This position offers the flexibility to customize your schedule while allowing you to leverage your clinical expertise in reviewing health claims. You'll play a critical role in ensuring the appropriateness of medical services, working closely with healthcare professionals. This independent contractor position provides a unique opportunity to balance work and life while contributing to quality healthcare outcomes. If you are passionate about making a difference in the medical field, this role is perfect for you.

Qualifications

• Board-certified MD or DO required with a solid understanding of network services.
• Must be actively practicing medicine to perform appeals.

Responsibilities

• Review medical files and provide recommendations for various claims.
• Communicate with providers about appeal processes and quality of care.

Skills

Medical Review

Utilization Review

Negotiation Skills

Communication Skills

Computer Proficiency

Education

Board-certified MD or DO

Current, unrestricted clinical license

Job description

Orthopedic Surgeon Telecommute Medical Review

3 weeks ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Overview

Are you an accomplished Board Certified Orthopedic Surgeon? 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 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, review 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 standards, as well as URAAC guidelines and state regulations.

Responsibilities

• Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, return to work, disability claims, FMLA, group health, and workers’ compensation claims.
• Meet (when required) with Concentra Physician Review Medical Director 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, documented criteria, and recommendations.
• 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 issues, 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 criteria used in reviews to requesting providers promptly.

Education/Credentials

• Board-certified MD or DO, with a solid understanding of network services, managed care, utilization, credentialing, and quality assurance.
• Current, unrestricted clinical license(s). If restricted, ensure job functions do not violate restrictions.
• Board certification by the American Board of Medical Specialties or Osteopathic Specialties is required.
• Must be actively practicing medicine to perform appeals.

Job-related Experience

Post-graduate experience in direct patient care.

Job-related Skills/Competencies

• Proficiency in computer and telephonic skills.
• Ability to perform review services effectively.
• Ability to collaborate with various professionals, including regulatory agency members, carriers, employers, nurses, and healthcare providers.
• Maintain no financial conflicts of interest in medical direction.
• Provide 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

• Access to a phone and computer for case reviews.
• Ability to complete cases and typed reports within specified timeframes.
• Participation in telephonic conferences.

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

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

Concentra's Data Protection Commitment:

• Committed to protecting patient data and ensuring privacy.
• All colleagues must adhere to data protection principles.
• If handling sensitive data, role-specific policies apply.

Additional Data

This position is an independent contractor role for Concentra.

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