Are you an accomplished Board Certified Anesthesiologist, Orthopedic Surgeon, or a Critical Care Provider? Certified in Pain Management, Occupational Medicine, Family Medicine or Internal Medicine? Are you passionate about your work/life balance?
We are seeking an engaging and accomplished physician for Medical ReviewStream by Concentra. In this position you will review health claims and provide medical interpretation according to URAAC guidelines and state regulations. Candidates can expect a flexible schedule and per case compensation as a 1099 contractor.
MAJOR DUTIES AND RESPONSIBILITIES:
- 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.
- Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
- Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
- Returns cases in a timely manner with clear concise and complete rationales and documented criteria.
- Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers.
- Attends orientation and training
- Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
- 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.
- Provides copies of any criteria utilized in a review to a requesting provider in a timely manner
- Board-certified MD/DO via the ABMS or AOBMS 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.
- 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)
- Must be in active medical practice to perform appeals with a minimum of five years experience with direct patient care
- We ask our preferred physician candidate to have an active TX or CA license.
- Post-graduate experience in direct patient care
- Demonstrated computer skills, telephonic skills
- Demonstrated ability to perform review services.
- Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals.
- Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest
- Must present evidence of current error and omissions liability coverage for job duties and activities performed
- Managed care orientation
- Knowledge of current practice standards in specialty
- Good negotiation and communication skills
WORKING CONDITIONS/PHYSICAL DEMANDS:
- Phone accessability
- Access to a computer to complete reviews
- Ability to complete cases accompanied by a typed report in specified time frames
- Telephonic conferences
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
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.