Spine Telecommute Medical Review Stream Physician

Concentra, Inc.; South San Francisco (CA); Remote; USD 250,000 - 350,000; Full time

Job summary

A leading healthcare provider is seeking a Board Certified Neurologist for a telecommute role in their Medical Reviewstream division. This independent contractor position allows for a flexible schedule while reviewing health claims and making medical decisions in compliance with established guidelines. Ideal candidates will possess a strong clinical background and effective communication skills.

Qualifications

• Current, unrestricted clinical license(s).
• Active medical practice experience to perform appeals.

Responsibilities

• Review medical files and provide recommendations for utilization review.
• Communicate telephonically with providers and other health professionals.
• Return cases promptly with clear, concise rationales.

Skills

Computer skills

Telephonic skills

Negotiation skills

Communication skills

Education

Board-certified MD or DO

Board certification by the American Board of Medical Specialties

Job description

Overview

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

MD License in California.

Are you passionate about 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, you will 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 with the Concentra Physician Review Medical Director as required to discuss quality of care, credentialing, and licensure issues.
3. Maintain proper credentialing, licenses, and certifications.
4. Return cases promptly with clear, concise, and complete rationales and documented criteria.
5. Communicate telephonically with providers and other health professionals professionally, discussing disclaimers and appeal processes.
6. Attend orientation and training sessions.
7. Perform other duties as assigned, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.
8. Utilize current criteria and resources such as national, state, and professional guidelines, and peer-reviewed literature to support objective decision-making.
9. Provide copies of criteria used in reviews to requesting providers promptly.

Qualifications

Educational and credential requirements include:

• Board-certified MD or DO with a strong understanding of network services, managed care, utilization, credentialing, and quality assurance.
• Current, unrestricted clinical license(s); if restricted, organizational processes ensure compliance.
• Board certification by the American Board of Medical Specialties or Osteopathic Specialties for MD or DO reviewers.
• Active medical practice experience to perform appeals.

Job-related skills and competencies include:

• Computer and telephonic skills.
• Ability to perform review services effectively.
• Ability to collaborate with various professionals, including regulatory agencies, carriers, employers, nurses, and healthcare providers.
• Knowledge of current practice standards in your specialty.
• Good negotiation and communication skills.

Working Conditions and Physical Demands

Must have:

• Phone accessibility.
• Access to a computer to complete reviews.
• Ability to complete cases with typed reports within specified timeframes.
• Telephonic conferencing capabilities.

This role involves access to confidential information, requiring discretion and secure information management.

Additional Information

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

Data Protection: Concentra commits to protecting patient data and ensuring privacy. All colleagues handling sensitive data must adhere to data protection policies.

Position Details

This is an independent contractor role for Concentra.

We are an equal opportunity employer, including for disability and veterans.