Internal Medicine Telecommute Medical Review Stream
About the position Responsibilities • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work. • Meets with the Concentra Physician Review Medical Director to discuss quality of care and credentialing issues when required. • Maintains proper credentialing and state licenses 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. • Attends orientation and training sessions. • Identifies and responds to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits. • Critiques and utilizes current criteria and resources to support sound decision-making in reviews. • Provides copies of any criteria utilized in a review to a requesting provider in a timely manner. Requirements • Board certified MD or DO with an excellent understanding of network services and managed care. • Current, unrestricted clinical license(s) in New Jersey. • Board certification by American Board of Medical Specialties or American Board of Osteopathic Specialties is required. • Post-graduate experience in direct patient care is necessary. • Demonstrated computer and telephonic skills. • Ability to work with various professionals including regulatory agencies, carriers, and healthcare professionals. • Evidence of current error and omissions liability coverage for job duties. Nice-to-haves • Managed care orientation. • Knowledge of current practice standards in specialty. • Good negotiation and communication skills. Benefits • Flexible work schedule. • Compensation on a per case basis as a 1099 independent contractor. Apply tot his job