Orthopedic Surgeon Telecommute Medical Review Stream Physician

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Overview

Are you an accomplished Board Certified Orthopedic Surgeon? We are seeking flexible and experienced physicians for our medical review stream division. This telecommute role offers the ability to customize your schedule and caseload within a Monday - Friday work week and during business hours. Compensation is on a per-case basis as a 1099 independent contractor. Candidates must have a CA license.

Job Summary

Relying on your clinical background, you will review health claims, providing medical interpretation and decisions regarding the appropriateness of services provided by other healthcare professionals, in compliance with Concentra Physician Review policies, procedures, and standards, as well as URAAC guidelines and state regulations.

Responsibilities

• Review medical files and provide recommendations on utilization review, chart reviews, medical necessity, appropriateness of care, return to work, disability claims, FMLA, and workers’ compensation.
• Coordinate with Concentra Physician Review Medical Director on quality of care and licensure issues.
• Maintain proper credentialing and licenses, including any required certifications.
• Provide clear, concise, and timely case reviews with documented rationales.
• Communicate professionally with healthcare providers, discussing disclaimers and appeals.
• Participate in orientation and training sessions.
• Respond to quality assurance issues, complaints, audits, or legal proceedings as needed.
• Use current guidelines and literature to support objective decision-making.
• Provide criteria used in reviews upon request.

Qualifications

• Board-certified MD or DO with understanding of network services, managed care, and utilization management.
• Current, unrestricted medical license(s) in CA.
• Active medical practice experience, with board certification by ABMS or AOBOS.

Skills and Competencies

• Strong computer and telephonic skills.
• Experience in medical review services.
• Ability to collaborate with various healthcare professionals and regulatory bodies.
• Knowledge of current practice standards in orthopedic surgery.
• Effective negotiation and communication skills.

Working Conditions

• Access to a computer and phone.
• Ability to complete reviews and reports within specified time frames.
• Telephonic conference capability.

This position requires handling sensitive information with discretion. Concentra is an Equal Opportunity Employer and committed to data protection.