PM&R Telecommute Medical Review Stream

Concentra; Houston (TX); Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Board Certified PM&R physician for a telecommute role that offers flexibility in schedule and caseload. This position allows you to leverage your clinical expertise in reviewing health claims and making decisions on medical appropriateness. With the ability to work from home, you will play a crucial role in ensuring quality care while maintaining compliance with regulations. If you are passionate about work/life balance and want to make a meaningful impact in the healthcare sector, this opportunity is perfect for you.

Qualifications

• Must be a Board Certified PM&R physician with a TX license.
• Experience in managed care and quality assurance is essential.

Responsibilities

• Review medical files for utilization review and medical necessity.
• Interact with healthcare professionals regarding appeals and claims.

Skills

Clinical Decision Making

Medical Review

Communication Skills

Negotiation Skills

Computer Skills

Telephonic Skills

Education

Board Certified MD or DO

Current Clinical License

Tools

Computer

Phone

Job description

Join to apply for the PM&R Telecommute Medical Review Stream role at Concentra

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Join to apply for the PM&R Telecommute Medical Review Stream role at Concentra

Overview

Are you an accomplished Board Certified PM&R physician? Candidates must have a TX license.

Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical review stream division. This telecommute role allows you to customize your schedule and caseload within a Monday - Friday work week and business hours. Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor.

Job Summary

Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals, in compliance with Concentra Physician Review policies, procedures, standards, URAAC guidelines, and state regulations.

Responsibilities

• Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, return to work, disability claims, FMLA, and workers’ compensation claims.
• Meets with Concentra Physician Review Medical Director as needed to discuss quality of care, credentialing, and licensure issues.
• Maintains proper credentialing and licenses, and any required certifications.
• Returns cases timely with clear, concise, and complete rationales and documented criteria.
• Contacts providers telephonically and interacts professionally with healthcare professionals, discussing disclaimers and appeal processes.
• Attends orientation and training sessions.
• Performs other duties including addressing quality assurance issues, regulatory compliance, court appearances, or audits.
• Utilizes current criteria and resources such as guidelines and literature to support sound decision-making.
• Provides copies of criteria used in reviews to requesting providers promptly.

Qualifications

• Board certified MD or DO with understanding of network services, managed care, utilization, credentialing, and quality assurance.
• Current, unrestricted clinical license(s). If restricted, organization ensures job functions comply with restrictions.
• Board certification by ABMS or AOBOS required for MD or DO reviewers.
• Must be in active medical practice to perform appeals.

Experience & Skills

• Post-graduate experience in direct patient care.
• Computer skills, telephonic skills, and ability to perform reviews.
• Ability to collaborate with various healthcare and regulatory professionals.
• Must have current error and omissions liability coverage.
• Managed care orientation and knowledge of current practice standards.
• Good negotiation and communication skills.

Working Conditions

• Access to a computer and phone for case reviews and communication.
• Ability to complete cases with typed reports within specified time frames.
• Telephonic conferences as needed.

This role involves handling confidential information, requiring discretion and secure data management.

Concentra is an Equal Opportunity Employer M/F/Disability/Veteran and commits to protecting patient data and privacy.