PM&R Telecommute Medical Review Stream Physician

Concentra, Inc.; Houston, Post Oak (TX, TX); Remote; USD 150,000 - 200,000; Full time

Job summary

An established industry player is on the lookout for a Board Certified PM&R physician to join their innovative telecommute team. This role offers the flexibility to customize your schedule and manage your caseload within a Monday to Friday work week. As an independent contractor, you will engage in critical medical review processes, ensuring quality care and compliance with regulations. Your expertise will be vital in providing recommendations for various medical claims, while collaborating with a diverse group of healthcare professionals. If you are passionate about maintaining work/life balance while making a significant impact in the medical field, this opportunity is tailored for you.

Qualifications

• Must be actively practicing medicine to perform appeals.
• Strong understanding of network services and managed care.

Responsibilities

• Review medical files and provide recommendations for utilization review.
• Interact professionally with health professionals regarding claims.

Skills

Strong computer skills

Telephonic skills

Negotiation skills

Communication skills

Ability to collaborate

Education

Board-certified MD or DO

Current, unrestricted clinical license

Board certification by the American Board of Medical Specialties

Job description

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 provides the ability for you to customize your schedule and caseload within a Monday - Friday work week and within business hours. Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor.

Responsibilities

MAJOR DUTIES AND RESPONSIBILITIES:

1. Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work, short and long-term disability, FMLA, group health, and workers’ compensation claims.
2. Meet (when required) with Concentra Physician Review Medical Director to discuss quality of care, credentialing, and licensure issues.
3. Maintain proper credentialing and state licenses, along with any special certifications necessary to perform the job.
4. Return cases in a timely manner with clear, concise, and complete rationales and documented criteria.
5. Telephonically contact providers and interact professionally with other health professionals, discussing disclaimers and appeal processes.
6. Attend orientation and training sessions.
7. Perform additional duties such as responding to quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.
8. Identify, critique, and utilize current criteria and resources to support sound decision-making in reviews.
9. Provide copies of utilized criteria to requesting providers promptly.

Qualifications

EDUCATION/CREDENTIALS:

• Board-certified MD or DO with a strong understanding of network services, managed care, utilization of services, credentialing, and quality assurance.
• Current, unrestricted clinical license(s); if restricted, organization must have a process to ensure compliance.
• Board certification by the American Board of Medical Specialties or Osteopathic Specialties for MD or DO reviewers.
• Must be actively practicing medicine to perform appeals.

JOB-RELATED EXPERIENCE:

• Post-graduate experience in direct patient care.

JOB-RELATED SKILLS/COMPETENCIES:

• Strong computer and telephonic skills.
• Experience with review services.
• Ability to collaborate with various professionals including regulatory agency members, carriers, employers, nurses, and healthcare providers.
• Provide medical direction without conflicts of interest.
• Evidence of current error and omissions liability coverage.
• Managed care orientation and knowledge of current practice standards.
• Good negotiation and communication skills.

Working Conditions/Physical Demands

• Access to a phone and computer.
• Ability to complete cases with typed reports within specified timeframes.
• Participation in telephonic conferences.

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

Concentra is an Equal Opportunity Employer M/F/Disability/Veteran

Concentra's Data Protection Commitment: We are committed to protecting patient data and ensuring privacy. All colleagues must adhere to data protection principles, especially when handling sensitive data.

Additional Data

This position is an independent contractor role for Concentra.

Concentra is an Equal Opportunity Employer, including for disability and veterans.