Pediatrician

Maximus; United States; Remote; USD 320,000 - 380,000; Full time

Job summary

Maximus is seeking a 100% Remote Pediatric Infectious Disease MD/DO Reviewer to perform medical expert judgment reviews to determine treatment coverage decisions. Candidates should have substantial experience in direct patient care and expertise in pediatric infectious disease. This role offers the opportunity to work on critical medical reviews, ensuring necessary treatments are provided based on established medical necessity standards.

Qualifications

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

Responsibilities

• Conduct medical expert judgement reviews based on denial of treatment.
• Assess medical necessity and experimental/investigational treatments.

Skills

Expert Review

Medical Necessity

Job description

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We are looking for a 100% Remote, 1099, Pediatric Infectious 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 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

Medical Necessity Review: 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

Volume: Varies based on need

Experimental/Investigational Reviews: 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

• Seniority level

  Not Applicable

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider and Consulting

• Industries

  Hospitals and Health Care and Government Administration

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