Physician Telecommute Medical Review Stream
Company: Concentra
Location: San Diego
Posted on: May 28, 2023
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Job Description:
Overview:Are you an accomplished Board Certified physician in
one of the below specialties? Candidates must have a CA
license.Family MedicineInternal MedicineOrthopedic SurgeryPhysical
Medicine & RehabilitationNeurologyAre 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.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
mannerQualifications: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 appealsJOB-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
conferencesThis job requires access to confidential and sensitive
information, requiring ongoing discretion and secure information
management.Concentra is an Equal Opportunity Employer
M/F/Disability/VeteranConcentra'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, San Diego , Physician Telecommute Medical Review Stream, Healthcare , San Diego, California
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