Physician Telecommute Medical ReviewStream
Company: Concentra
Location: Reno
Posted on: April 15, 2024
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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
reviewstream 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 NV license.
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:
* 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
Qualifications
EDUCATION/CREDENTIALS:
* 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. -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); -Board certification
by American Board of Medical specialties or American Board of
Osteopathic Specialties is required for MD or DO reviewer. -Must be
in active medical practice to perform appeals JOB-RELATED
EXPERIENCE:Post-graduate experience in direct patient
careJOB-RELATED SKILLS/COMPETENCIES: -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 skillsWORKING 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 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
Keywords: Concentra, Sparks , Physician Telecommute Medical ReviewStream, Healthcare , Reno, Nevada
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