Physician Peer Reviewer- Endocrinology

FHAS, LLC; Michigan; Remote; USD 180,000 - 240,000; Full time

Job summary

FHAS, LLC, a URAC-accredited Independent Medical Review Organization, is expanding its elite panel of physicians licensed to assist with independent review claims and appeals. The role involves reviewing medical case files, applying medical necessity criteria, and rendering timely determinations.

Ideal candidates hold an MD or DO license in the U.S., board certification, and at least 5 years of post-graduate experience with recent patient care. Remote work is possible for qualified applicants.

Qualifications

• Residency or fellowship completed.
• Current state medical license in the U.S.
• Unrestricted license with license type allowing clinical judgment.
• Board certification by ABMS or AOA.
• 5+ years post-graduate clinical experience.
• Direct patient care in past 3 years if performing external reviews.

Responsibilities

• Review medical case files and render determinations on medical necessity and appropriateness.
• Review and analyze federal and state laws, regulations, and policy guides.
• Complete reviews within regulatory timeframes.

Skills

Residency/Fellowship

Active medical licensure

Unrestricted license

Board certification

5+ years clinical experience

Recent direct patient care

Education

Doctor of Medicine (MD)

Doctor of Osteopathic Medicine (DO)

ABMS or AOA board certification

Job description

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:

Addiction Medicine, Allergy & Immunology, Anesthesiology, Cardiovascular Disease, Child & Adolescent Psychiatry, Chiropractic Medicine, Dentist, Dermatology, Emergency Medicine, Endocrinology, Diabetes, & Metabolism, Family Medicine, Gastroenterology, Internal Medicine, Interventional Cardiology, Interventional Radiology & Diagnostic Radiology, Medical Genetics & Genomics, Medical Oncology, Nephrology, Neurological Surgery, Neurology, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Pain Medicine, Pathology, Pediatrics, Pediatric Cardiology, Pediatric Critical Care Medicine, Developmental-Behavioral Pediatrics, Pediatric Emergency Medicine, Pediatric Gastroenterology, Pediatric Nephrology, Physical Medicine & Rehabilitation, Plastic Surgery, Psychiatry, Psychology *PhD, Radiation Oncology, Radiology, Rheumatology, Sleep Medicine, Thoracic & Cardiac Surgery, Transplant Hepatology, Undersea & Hyperbaric Medicine

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