Concentra, Inc
Emergency Medicine Telecommute Medical Review Stream Physician
Concentra, Inc, Dallas, Texas, United States, 75215
Emergency Medicine Telecommute Medical Review Stream Physician
Location: US‑TX‑Dallas
Position Type: Contract | Path: Medical Review (UR)
Overview Are you an accomplished
Board Certified physician
in one of the following specialties? Preferred candidates will have a TX license.
General Surgery
Neurologist
Orthopedic Surgery with hand or spine specialty
Physical Medicine & Rehabilitation
Plastic Surgery
Podiatrist
We are seeking flexible and experienced physicians for our medical review stream division. This telecommute role allows you to customize your schedule and caseload during a Monday‑Friday work week within business hours. You will be compensated on a per‑case basis as a 1099 independent contractor.
Job Summary Relying on clinical background, you will review 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, URAAC guidelines, and state regulations.
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, FMLA, group health and workers' compensation claims.
Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care, credentialing, and state licensure issues.
Maintains proper credentialing, 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, discussing appropriate DISCLAIMERS and appeal process with 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 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 care.
Job‑Related Skills/Competencies:
Demonstrated computer and 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 accessibility.
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 protecting patient data and ensuring privacy of personal and medical information. Every Concentra colleague has the responsibility to adhere to data protection principles. Role‑specific policies and requirements apply to ensure the protection of patient information.
Additional Information This position is an independent contractor role for Concentra.
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Position Type: Contract | Path: Medical Review (UR)
Overview Are you an accomplished
Board Certified physician
in one of the following specialties? Preferred candidates will have a TX license.
General Surgery
Neurologist
Orthopedic Surgery with hand or spine specialty
Physical Medicine & Rehabilitation
Plastic Surgery
Podiatrist
We are seeking flexible and experienced physicians for our medical review stream division. This telecommute role allows you to customize your schedule and caseload during a Monday‑Friday work week within business hours. You will be compensated on a per‑case basis as a 1099 independent contractor.
Job Summary Relying on clinical background, you will review 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, URAAC guidelines, and state regulations.
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, FMLA, group health and workers' compensation claims.
Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care, credentialing, and state licensure issues.
Maintains proper credentialing, 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, discussing appropriate DISCLAIMERS and appeal process with 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 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 care.
Job‑Related Skills/Competencies:
Demonstrated computer and 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 accessibility.
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 protecting patient data and ensuring privacy of personal and medical information. Every Concentra colleague has the responsibility to adhere to data protection principles. Role‑specific policies and requirements apply to ensure the protection of patient information.
Additional Information This position is an independent contractor role for Concentra.
#J-18808-Ljbffr