Spine Telecommute Medical Review Stream Physician

Concentra, Inc.; Albuquerque (NM); Remote; USD 150,000 - 250,000; Full time

Job summary

An established industry player is seeking accomplished Board Certified physicians for a flexible telecommute role in their medical review stream division. This position allows you to customize your schedule and caseload, ensuring a work/life balance while reviewing health claims and providing medical interpretations. Ideal candidates will have a strong clinical background and the ability to make informed decisions in compliance with healthcare policies and regulations. Join a progressive team that values your expertise and offers a supportive environment for professional growth.

Qualifications

• Board certified physician with an active clinical license required.
• Post-graduate experience in direct patient care is essential.

Responsibilities

• Review medical files for utilization and appropriateness of care.
• Maintain proper credentialing and state licenses for the role.

Skills

Computer Skills

Telephonic Skills

Negotiation Skills

Communication Skills

Education

Board Certified MD or DO

Active Clinical License

Board Certification by Medical Specialties

Tools

Computer

Telecommunication Tools

Job description

Overview

Are you an accomplished Board Certified physician in one of the below specialties? 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. Candidates must have a NM license.

• Anesthesiology
• Neurosurgeon
• Orthopedic Surgeon
• Pain Medicine

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, and performance standards and URAAC guidelines and state regulations.

Responsibilities

MAJOR DUTIES AND RESPONSIBILITIES:

1. Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health, and workers’ compensation claims.
2. Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
3. Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
4. Returns cases in a timely manner with clear, concise, and complete rationales and documented criteria.
5. Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers.
6. Attends orientation and training.
7. Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
8. Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision making and rationales in reviews.
9. Provides copies of any criteria utilized in a review to a requesting provider in a timely manner.

Qualifications

EDUCATION/CREDENTIALS:

1. Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance, and the development of policies that support these services.
2. Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board).
3. Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
4. Must be in active medical practice to perform appeals.

JOB-RELATED EXPERIENCE: Post-graduate experience in direct patient care.

JOB-RELATED SKILLS/COMPETENCIES:

1. Demonstrated computer skills, telephonic skills.
2. Demonstrated ability to perform review services.
3. Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses, and health care professionals.
4. Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest.
5. Must present evidence of current error and omissions liability coverage for job duties and activities performed.
6. Managed care orientation.
7. Knowledge of current practice standards in specialty.
8. Good negotiation and communication skills.

WORKING CONDITIONS/PHYSICAL DEMANDS:

1. Phone accessibility.
2. Access to a computer to complete reviews.
3. Ability to complete cases accompanied by a typed report in specified time frames.
4. Telephonic conferences.

This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

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

Concentra's Data Protection Commitment

Concentra is committed to protect patient data and to ensure privacy of personal and medical information. Every Concentra colleague has the responsibility to adhere to data protection principles. If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

Additional Data

Concentra is an Equal Opportunity Employer, including disability/veterans.