Physician Peer Reviewer- Endocrinology

FHAS Federal Hearings & Appeals Services, Inc.; Wilkes-Barre (Luzerne County); On-site; USD 96,432 - 165,312; Part time

Job summary

FHAS Federal Hearings & Appeals Services, Inc. is expanding its elite panel of physicians to conduct independent medical reviews.

The role involves reviewing medical case files, determining medical necessity and appropriateness, and addressing regulatory guidelines under the Bureau of Hearings and Appeals. Candidates must have an MD or DO, completed residency/fellowship, current medical license, ABMS/AOA board certification, and 5+ years of post-graduate clinical experience with recent patient

Qualifications

• Residency or Fellowship completion required.
• Current state medical license in the US; unrestricted and in the jurisdiction of the contract.
• Board certification by ABMS or AOA required.
• 5+ years of post-graduate clinical experience in direct patient care.
• Recent direct patient care experience within the last 3 years if performing external reviews.

Responsibilities

• Review medical case files and render medical determinations (e.g., medical necessity, appropriateness, or related issues).
• Evaluate Federal/State laws, regulations, and policy guides relevant to reviews.
• Complete and evaluate the review process within regulatory timeframes.

Skills

Medical review

Regulatory knowledge

Clinical judgement

Education

MD/DO

Residency/Fellowship

Board certification (ABMS/AOA)

Job description

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.

Contractor - 1099 Wilkes-Barre, PA, US

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