Pediatrician

Maximus; United States; Remote; USD 80,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated Pediatric Gastroenterology Disease MD/DO Reviewer for a fully remote role. In this position, you will leverage your expertise to conduct medical necessity reviews, ensuring that patients receive appropriate treatment coverage. With a focus on both standard and expedited cases, you will play a crucial role in evaluating treatments based on their necessity and investigational status. This contract position offers flexibility and the opportunity to work from your own personal computer while collaborating with a supportive training team. If you are passionate about healthcare and looking to make a difference, this role is perfect for you.

Qualifications

• 5+ years of experience in Pediatric Gastroenterology post training.
• 24 hours of direct patient care per week required.

Responsibilities

• Conduct medical reviews to determine treatment coverage based on medical necessity.
• Complete reviews in a timely manner, adhering to turnaround times.

Skills

Medical Expert Judgement

Pediatric Gastroenterology

Patient Care

Medical Necessity Evaluation

Tools

Web-based portal

Templates for reviews

Job description

We are looking for a 100% Remote, 1099, Pediatric Gastroenterology Disease 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: Pediatric Gastroenterology

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.
• 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.
• 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.

Seniority level

Not Applicable

Employment type

Contract

Job function

Health Care Provider and Consulting

Industries

Hospitals and Health Care and Government Administration