Ophthalmologist Telecommute Medical Review Stream Physician

Overview

Are you an accomplished Board Certified Ophthalmologist
? Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical review‑stream 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.

Candidates must have a Louisiana license.

JOB SUMMARY: Using your clinical background, you will review health claims, providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals. You must comply 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 determinations for short‑ and long‑term disability, Family and Medical Leave Act (FMLA), group health, and workers' compensation claims.
• Meet (when required) with Concentra Physician Review Medical Director to discuss quality of care, credentialing, and state licensure issues.
• Maintain proper credentialing, state licenses, and any special certifications or requirements necessary to perform the job.
• Return cases in a timely manner with clear, concise, and complete rationales and documented criteria.
• Telephonically contact providers and interact with other health professionals professionally, discussing appropriate disclosures and the appeal process.
• 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 that support sound and objective decision making and rationales in reviews.
• Provide copies of any criteria utilized in a review to a requesting provider in a timely manner.

Education/Credentials:

• Board‑certified MD or DO with an excellent understanding of network services and managed care, appropriate utilization of services, credentialing, quality assurance, and policy development.
• Current, unrestricted clinical license(s) (or a restricted license with an acceptable process to ensure job functions comply with state board restrictions).
• Board certification by the American Board of Medical Specialties or the American Board of Osteopathic Specialties (required for MD or DO reviewers).
• 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.
• Ability to perform review services.
• Ability to work with various professionals including regulatory agencies, carriers, employers, nurses, and other health‑care professionals.
• Medical direction shall be provided consistently with the requirement that the physician advisor shall not have a financial conflict of interest.
• Evidence of current error‑and‑omission 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 within 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 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.
• If a colleague’s role includes handling or processing sensitive data, role‑specific policies and requirements apply to ensure the protection of patient information.