Physician Reviewer Multiple Specialties - Indiana and Nevada

FHAS Federal Hearings & Appeals Services, Inc.; Indiana (PA); Hybrid; USD 120,000 - 170,000; Full time

Job summary

FHAS Federal Hearings & Appeals Services, Inc. is seeking a Physician Peer Reviewer with multiple specialties to review medical claims and determine medical necessity and appropriateness for Federal and State review processes.

Candidates must hold an active medical license in Indiana or Nevada, be board-certified, and have 5+ years of post-graduate experience with recent direct patient care. The role requires independent judgment and timely completion of reviews.

Qualifications

• Completion of a Residency or Fellowship Program.
• Current state license in the United States in the relevant jurisdictions.
• Unrestricted license and no disqualifying restrictions.
• License permits applying clinical judgement in consideration of patient needs.
• Must have the same licensure as the ordering practitioner.
• Board certification by ABMS or AOA.
• 5+ years post-graduate clinical experience.
• Experience providing direct patient care within the past 3 years if performing external reviews.

Responsibilities

• Review medical case files and make medical determinations, including medical necessity and appropriateness.
• Review and analyze Federal and State laws, regulations, and policy guides.
• Complete and evaluate the review process within regulatory timeframes.

Education

Residency or Fellowship Program

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.

Physician Reviewer Multiple Specialties - Indiana and Nevada

Contractor - 1099 Wilkes-Barre, PA, US

30+ days ago Requisition ID: 1013

Physician Peer Reviewer – Multiple Specialties in Texas and/or New Mexico

Overview

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 in the state of Indiana and Nevada 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 clinical experience in direct patient care
• Experience providing direct patient care within the past 3 years, if performing external reviews