Spine Telecommute Medical Review Stream Physician

Concentra, Inc.; North Sacramento (CA); Remote; USD 120,000 - 180,000; Full time

Job summary

An established industry player is seeking a Board Certified Neurologist to join its Medical Reviewstream division. This telecommute role offers the flexibility to customize your schedule and caseload, allowing you to balance work and life effectively. As an independent contractor, you'll be responsible for reviewing health claims and making medical decisions in compliance with established guidelines. This position not only values your clinical expertise but also emphasizes the importance of communication and collaboration with healthcare professionals. If you're passionate about patient care and looking for a role that offers both independence and impact, this opportunity is perfect for you.

Qualifications

• Board certified MD or DO with strong understanding of managed care.
• Active medical practice required for performing appeals.

Responsibilities

• Review medical files and provide recommendations for utilization review.
• Communicate professionally with providers about appeal processes.

Skills

Patient Care

Medical Review

Communication Skills

Negotiation Skills

Telephonic Skills

Education

Board Certified MD or DO

Current Clinical License

Tools

Computer

Telephone

Job description

Overview

Are you an accomplished Board Certified Neurologist in one of the below specialties?

MD License in California.

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

Job Summary

Relying on your clinical background, review 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, performance standards, URAAC guidelines, and state regulations.

Responsibilities

Major duties include:

1. Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, return to work, disability claims, FMLA, and workers’ compensation claims.
2. Meet (when required) with the Concentra Physician Review Medical Director to discuss quality of care, credentialing, and licensure issues.
3. Maintain proper credentialing, licenses, and certifications.
4. Return cases timely with clear, concise, and complete rationales and documented criteria.
5. Communicate professionally with providers, 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. Utilize current guidelines and resources to support sound decision-making.
9. Provide copies of criteria used in reviews to requesting providers promptly.

Qualifications

Education and 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, ensure job functions do not violate restrictions.
• Board certification by ABMS or AOBOS is required for MD or DO reviewers.
• Must be in active medical practice to perform appeals.

Experience and Skills:

• Post-graduate experience in direct patient care.
• Strong computer and telephonic skills.
• Ability to perform reviews and work collaboratively with various professionals.
• Provide evidence of 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 completing reviews.

- Ability to complete cases within specified timeframes.

- Telephonic conferences.

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

Additional Information

This position is an independent contractor role for Concentra.

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

Concentra is committed to protecting patient data and ensuring privacy, with role-specific policies for handling sensitive information.