Are you an accomplished Board Certified Anesthesiologist ? C andidates must have a NJ license
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.
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.
Benefits
This position is an independent contractor role for Concentra.
Concentra is an Equal Opportunity Employer, including disability/veterans
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
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.
...Promotes and restores patients'/residents' health by completing the nursing process; collaborating with physicians and multidisciplinary team members; providing physical and psychological support to patients/residents, friends, and families. Job Duties: Identifies...
..., a global professional services firm located in DTLA is seeking dynamic and progressive Senior Quantitative Analyst ideally with CFA, M&A from Investment Banking background to join their elite Quantitative Analysis team within Global Services Office. The success of...
...South America, and India. Role: The FSQ Manager is responsible for ensuring the maintenance and continuous improvement of foodsafety and quality standards within an organization. This role requires expertise in food safetyregulations, quality control methodologies...
...Whats brewing in your future? If youre striving for a glass half-full rather than half-empty, become a master of mixology as a Bartender with Aramark! Surrounded by passionate teammates and leaders, youll help take our meals to the next level with knowledge of your...
...We are seeking a Business Development Assistant to join our team and contribute to our continued growth. With a focus on customer satisfaction and personal development , we offer team-based training sessions led by top executives, fostering a collaborative environment...