Hematologist

Overview

Be among the first 25 applicants. This is a 100% Remote, 1099 Hematology Oncology MD/DO Reviewer position. Direct message the job poster from Maximus.

Job Description:

Medical Expert Reviewer for Medical Expert Judgement Reviews determining final decision based on enrollee’s denial of treatment coverage denied by the CA DMHC (Department of Managed Health Care). Reviews are based on Medical Necessity and Experimental/Investigational considerations. Specialty-driven expert within the requested specialty.

• Provide thorough and professional medical reviews to determine whether a treatment should be covered by CA DMHC.
• Base reviews on medical necessity and whether the treatment is experimental or investigational.
• Serve as a specialty-driven expert within the requested field.
• Access a web-based portal using your own personal computer.
• Participate in review training with the trainer for the first 3–5 cases.
• Follow scheduled training based on the reviewer’s availability.
• Utilize templates to complete reviews.

Expert reviewers use a web-based portal accessed from a personal computer.

• 24 hours of direct patient care per week.
• 5 years of post-training experience in the appropriate specialty.

• Medical Necessity Review:
  Standard Case — most common type; 30–45 minutes to complete; 5–7 day turnaround.
• Medical Necessity Review:
  Expedited Case — sickest patients; 24-hour turnaround; 45 minutes to 1 hour to complete.
• Experimental/Investigational Reviews:
  Standard Case — second most common; 1–2 hours to complete with 5–7 day turnaround.
• Experimental/Investigational Reviews:
  Expedited Case — sickest patients; 24-hour turnaround; 1–2 hours to complete.

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