Spine Telecommute Medical Review Stream Physician

Concentra, Inc; Albuquerque (NM); Remote; USD 80,000 - 150,000; Full time

Job summary

An established industry player is seeking experienced Board Certified physicians for a telecommute role in their medical review stream division. This position offers flexible scheduling within a Monday to Friday work week, allowing for a healthy work/life balance. As an independent contractor, you will review health claims, provide medical interpretations, and ensure compliance with policies and regulations. Ideal candidates will have a strong clinical background and a current NM license. If you're passionate about making impactful decisions in healthcare while enjoying flexibility, this opportunity is perfect for you.

Qualifications

• Board certified physician with experience in managed care and credentialing.
• Current NM clinical license required for the role.

Responsibilities

• Review medical files for utilization review and appropriateness of care.
• Communicate with providers and maintain proper credentialing.
• Provide timely case reviews with clear rationales.

Skills

Post-graduate patient care experience

Computer and telephonic skills

Effective communication with professionals

Negotiation skills

Managed care orientation

Education

Board certified MD or DO

Current unrestricted clinical license in NM

Board certification by recognized boards

Job description

Spine Telecommute Medical Review Stream Physician

Location: US-NM-Albuquerque

Job ID	297065
Pos. Category	Medical - Medical Review - UR
Pos. Type	Contract

Overview

Are you a Board Certified physician passionate about work/life balance? We seek experienced physicians for our medical review stream division. This telecommute role offers flexible scheduling within a Monday - Friday work week and business hours. Compensation is on a per case basis as a 1099 independent contractor. Candidates must have an NM license.

• Anesthesiology
• Neurosurgery
• Orthopedic Surgery
• Pain Medicine

Job Summary: Using your clinical background, review health claims, provide medical interpretation, and make decisions regarding the appropriateness of services, in compliance with policies, procedures, standards, and regulations.

Responsibilities

1. Review medical files and recommend on utilization review, chart reviews, medical necessity, appropriateness of care, and disability claims.
2. Meet with Medical Director as needed to discuss quality of care and licensure issues.
3. Maintain proper credentialing and licenses.
4. Provide timely case reviews with clear rationales.
5. Communicate professionally with providers.
6. Attend orientation and training.
7. Respond to quality assurance issues, complaints, and regulatory matters.
8. Utilize current guidelines and literature to support reviews.
9. Provide criteria used in reviews upon request.

Qualifications

Education & Credentials:

• Board certified MD or DO with understanding of network services, managed care, and credentialing.
• Current, unrestricted clinical license in NM.
• Board certification by recognized boards for MD or DO.
• Active medical practice experience.

Experience & Skills:

• Post-graduate patient care experience.
• Computer and telephonic skills.
• Ability to perform reviews and communicate effectively with professionals.
• Evidence of current error and omissions liability coverage.
• Managed care orientation and knowledge of specialty standards.
• Good negotiation and communication skills.

Working Conditions

Access to a computer, phone, and ability to complete cases within specified timeframes. Role involves handling sensitive information with discretion.

Concentra is an Equal Opportunity Employer and committed to data protection and privacy.