Physician Peer Reviewer- Endocrinology

FHAS, LLC; Wilkes-Barre (Luzerne County); On-site; USD 165,000 - 358,000; Part time

Job summary

FHAS, LLC in Wilkes-Barre, PA is expanding its panel of physicians to conduct independent medical reviews (IRO) and appeals for healthcare organizations and government entities. This 1099 contractor role involves reviewing medical records, applying medical judgment, and issuing determinations within regulatory timeframes.

Applicants must have completed a residency or fellowship, hold an active US MD/DO license, board certification, and at least five years of post-graduate clinical experience,

Qualifications

• Responsible for reviewing medical case files and making medical determinations.
• Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
• Completes and evaluates the review process in a regulatory timeframe.

Responsibilities

• Review medical case files and render medical determinations including medical necessity and appropriateness, and related issues.
• Analyze Federal/State laws and policy guides relevant to reviews and decisions.
• Complete and evaluate the review process within regulatory timeframes.

Skills

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

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

Education

Residency or Fellowship Program

Current US medical license (MD/DO)

Board certification by ABMS or AOA

5+ years post graduate clinical experience

Recent direct patient care experience (past 3 years)

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.

67 - IRO Reviews Contractor - 1099 Wilkes-Barre, PA, US

30+ days ago Requisition ID: 1022

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