Pediatrician

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

Job summary

An innovative healthcare provider is seeking a remote Pediatric Infectious Disease MD/DO Reviewer to conduct expert medical reviews. This role involves assessing treatment necessity and determining coverage decisions based on medical necessity and investigational status. As part of this dynamic team, you will leverage your expertise to ensure that patients receive the care they need while navigating complex medical guidelines. If you are passionate about making a difference in the healthcare landscape and possess a strong background in pediatric infectious diseases, this opportunity is perfect for you.

Qualifications

• 5 years’ experience in Pediatric Infectious Disease post training.
• 24 hours of direct patient care per week required.

Responsibilities

• Conduct medical reviews to determine treatment coverage based on necessity.
• Utilize templates and web-based tools for efficient review processes.

Skills

Medical Expert Judgment

Pediatric Infectious Disease Expertise

Patient Care

Review Training

Education

MD/DO

Tools

Web-based portal

Templates for reviews

Job description

We are looking for a 100% Remote, 1099, Pediatric Infectious Disease MD/DO Reviewer

Description:

1. Medical Expert Reviewer-Medical Expert Judgement Reviews determining final decision based off enrollee’s denial of treatment-coverage denied by the CA DMHC.
2. Reviews are based off Medical Necessity and Experimental/Investigational.
3. 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 Infectious Disease

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.

Keith Stewart
Clinical Recruiter

Seniority level

Not Applicable

Employment type

Contract

Job function

Health Care Provider and Consulting

Industries

Hospitals and Health Care and Government Administration