Physical Medicine & Rehabilitation Telecommute Medical Review Stream Physician

Concentra, Inc.; Albuquerque (NM); Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Board Certified Physical Medicine & Rehabilitation physician for a flexible telecommute role. This position allows you to customize your schedule while reviewing health claims and making medical interpretations. You will work within a Monday to Friday framework, ensuring compliance with various guidelines and providing essential insights into the appropriateness of care. Join a team that values work/life balance and offers the autonomy to manage your caseload effectively. Your expertise will directly impact the quality of healthcare services delivered.

Qualifications

• Board certification and current clinical license required.
• Post-graduate experience in direct patient care is necessary.

Responsibilities

• Review medical files and provide recommendations for utilization review.
• Communicate with providers regarding claims and appeal processes.
• Maintain proper credentialing, licenses, and certifications.

Skills

Telephonic skills

Negotiation skills

Computer skills

Knowledge of current practice standards

Education

Board-certified MD or DO

Current, unrestricted clinical license

Board certification by ABMS or AOA

Job description

Overview

Are you an accomplished Board Certified Physical Medicine & Rehabilitation physician? Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our Medical Reviewstream 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. Candidates must have an NM license.

Job Summary

Relying on your clinical background, you will review health claims, providing medical interpretation and decisions regarding the appropriateness of services provided by other healthcare professionals, in compliance with Concentra Physician Review policies, procedures, performance standards, URAAC guidelines, and state regulations.

Responsibilities

Major Duties and Responsibilities:

1. Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, return to work, disability claims, FMLA, and workers’ compensation claims.
2. Meet with the Concentra Physician Review Medical Director as required to discuss quality of care, credentialing, and licensure issues.
3. Maintain proper credentialing, licenses, and certifications necessary for the role.
4. Return cases promptly with clear, concise, and complete rationales, documented criteria, and rationales.
5. Communicate telephonically with providers and other health professionals professionally, discussing disclaimers and appeal processes.
6. Attend orientation and training sessions.
7. Perform additional duties such as responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
8. Utilize current criteria and resources, including national, state, and professional guidelines, as well as peer-reviewed literature, to support sound decision-making.
9. Provide copies of criteria used in reviews to requesting providers promptly.

Qualifications

Education and 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); if restricted, organization must have a process to ensure compliance.
• Board certification by the American Board of Medical Specialties or the American Osteopathic Association is required.
• Active medical practice experience necessary for appeals.

Job-Related Experience: Post-graduate experience in direct patient care.

Skills and Competencies:

• Demonstrated computer and telephonic skills.
• Ability to perform review services effectively.
• Ability to work with regulatory agencies, carriers, employers, nurses, and healthcare professionals.
• Knowledge of current practice standards in your specialty.
• Good negotiation and communication skills.
• Evidence of current error and omissions liability coverage.
• Managed care orientation.

Working Conditions and Physical Demands

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

This role requires access to confidential and sensitive information, necessitating discretion and secure information management.

Additional Information

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

Data Protection: Concentra is committed to protecting patient data and ensuring privacy. All colleagues handling sensitive data must adhere to data protection principles and role-specific policies.