Spine Surgeon Telecommute Medical Review Stream Physician

Overview

Are you an accomplished Board Certified Orthopedic or Neurosurgeon physician? This telecommute role offers a flexible schedule within a Monday - Friday work week and business hours. Compensation is on a per‑case basis as a 1099 independent contractor. Candidates must have a CA license.

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, performance standards, URAAC guidelines, and state regulations.

• Review medical files and provide 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.
• Meet with Concentra Physician Review Medical Director (when required) to discuss quality of care, credentialing, and state licensure issues.
• Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
• Return cases in a timely manner with clear, concise, complete rationales and documented criteria.
• Contact providers telephonically and interact with other health professionals in a professional manner; discuss the appropriate disclaimers and appeal process with providers.
• Attend orientation and training.
• Perform other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
• Identify, critique, and utilize current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature to support sound and objective decision making.
• Provide copies of any criteria utilized in a review to a requesting provider in a timely manner.

• Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance, and policy development.
• Current, unrestricted clinical license(s) (or if restricted, organization has a process to ensure job functions do not violate restrictions).
• 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.

Post-graduate experience in direct patient care.

• Demonstrated computer and telephonic skills.
• Ability to perform review services.
• Ability to work with various professionals including regulatory agencies, carriers, employers, nurses, and other health care professionals.
• Medical direction must be provided without financial conflict of interest.
• Evidence of current errors and omissions liability coverage.
• Managed care orientation.
• Knowledge of current practice standards in specialty.
• Good negotiation and communication skills.

• Phone accessibility and 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 apply to ensure protection of patient information.

Concentra is an Equal Opportunity Employer, including disability/veterans.