MCMC
Description
MCMC is recruiting physician reviewers to join our peer review panel. This is a remote, consultant position. MCMC provides independent medical reviews of the highest possible quality to health plans, health insurers, self-insured employers, and anyone else who wants an independent, objective opinion about the facts of a medical care case. We review cases in all domains of medicine, at all levels of technology, for all age groups.
Responsibilities
- Evaluate clinical requests for medical necessity and medical appropriateness, experimental or investigational treatment or both, from various referral sources.
- Utilizes clinical judgment in conjunction with relevant health plan criteria or guidelines to substantiate service requests.
- Contacts the attending provider and remains professional and objective during this interaction.
- Supports every recommendation with a clear, precise rationale based on the clinical facts available for review.
- Completes all reviews within the specified turn-around-time.
- Completes all reviews according to MCMC operational directions and client specific instructions, in a clear and comprehensive fashion.
- Consults collaboratively with clinical and non-clinical team members.
- Adheres to URAC, NCQA, ERISA, and other applicable regulatory and legislative requirements and standards.
- Other duties as assigned.
Qualifications
Education
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
Skills
- Knowledge of current practice standards.
- Strong oral communication and interpersonal skills.
- Strong computer skills with the ability to learn new applications.
- Strong analytical skills.
- Ability to work independently and with a team.
- Ability to work in a dynamic, fast-paced environment.
Experience
- 5 or more years post graduate experience in direct patient care.
Licenses & Certifications
- Must have an active, unrestricted U.S. medical license.
- Must be Board Certified in Orthopaedic Surgery by the ABOS or AOBOS.
