Physician Peer Reviewer- Dermatologist

FHAS Federal Hearings & Appeals Services, Inc.; Wilkes-Barre (Luzerne County); Sur place; USD 110 000 - 165 000; Temps partiel

Résumé du poste

FHAS Federal Hearings and Appeals Services, Inc. is seeking a Physician Peer Reviewer – Geriatric Psychiatrist to join its independent medical review panel on a contractor (1099) basis in Wilkes-Barre, PA.

Candidates must hold an MD or DO, be licensed in New Jersey, have board certification (ABMS or AOA), and 5+ years of direct patient care post graduate experience; responsibilities include reviewing medical files, applying laws and policies, and delivering timely determinations.

Qualifications

• Residency or Fellowship completed.
• MD or DO with current state license.
• Board certification by ABMS or AOA.

Responsabilités

• Review medical case files and render medical determinations.
• Analyze Federal and State laws, regulations and policy guides.
• Complete reviews within regulatory timeframes.

Connaissances

Regulatory review

Clinical decision making

Medical judgment

Formation

MD/DO

Residency or Fellowship

Board certification ABMS/AOA

Description du poste

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Physician Peer Reviewer- Geriatric Psychiatrist

Contractor - 1099 Wilkes-Barre, PA, US

7 days ago Requisition ID: 1011

Physician Peer Reviewer - Geriatric Psychiatrist - MUST BE LICENSED IN NEW JERSEY

Federal Hearings and Appeals Services (FHAS) is a URAC-accredited Independent Medical Review Organization (IRO) with Health Utilization Management (HUM) accreditation. For the past 30 years, FHAS has provided external peer review services to healthcare organizations, government agencies, insurance companies, and legal entities.

FHAS is currently expanding its elite panel of physicians licensed to assist with independent review claims and appeals in any of the following specialties:

Geriatric Psychiatrist - MUST BE LICENSED IN NEW JERSEY

Description

• Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA).
• Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
• Completes and evaluates the review process in a regulatory timeframe.

Work Experience Requirements

• Successful completion of a Residency or Fellowship Program
• Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
• License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
• License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
• For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
• Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
• 5-years or more post graduate active clinical experience in direct patient care
• Experience providing direct patient care within the past 3 years, if performing external reviews