Emergency Medicine Telecommute Medical Review Stream Physician Job Wisconsin USA,Doctor/Physician

Are you an accomplished Board Certified physician in one of the below specialties? Preferred candidates will have a TX license.

General Surgery
Neurologist
Orthopedic Surgery with hand or spine specialty
Physical Medicine & Rehabilitation
Plastic Surgery
Podiatrist

Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our Medical Reviewstream division. This telecommute role allows you 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.

Job Summary:

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

Major

Duties and Responsibilities:

Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, return to work, disability claims, FMLA, and insurance claims.

Meet with Concentra Physician Review Medical Director as required to discuss quality of care and credentialing issues.

Maintain proper credentialing and licenses, including any required certifications.

Complete reviews promptly with clear, concise, and well-documented rationales.

Contact providers telephonically and interact professionally with healthcare professionals, discussing disclaimers and appeal processes.

Attend orientation and training sessions.

Perform additional duties such as addressing quality assurance issues, regulatory concerns, and participating in audits.

Utilize current criteria and resources, including national and state guidelines, to support objective decision-making.

Provide copies of review criteria to requesting providers in a timely manner.

Qualifications:

Board-certified MD or DO with a strong understanding of network services, managed care, and credentialing.
Current, unrestricted clinical license(s); if restricted, organization must ensure compliance with restrictions.
Board certification by American Board of Medical Specialties or Osteopathic Specialties for MD or DO reviewers.
Active medical practice experience for performing appeals.

Experience and Skills:

Post-graduate experience in direct patient care.
Strong computer and telephonic skills.
Ability to perform review services effectively.
Ability to collaborate with professionals, including regulatory agencies, carriers, and healthcare providers.
Evidence of current error and omissions liability coverage.
Managed care orientation and knowledge of current specialty standards.
Good negotiation and communication skills.

Working Conditions:

Access to a phone and computer for case reviews.
Ability to complete cases and reports within specified time frames.
Participation in teleconferences.

This role involves handling confidential information, requiring discretion and secure data management.

Concentra is an Equal Opportunity Employer and commits to protecting patient data and privacy. This position is an independent contractor role.

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