Physician Emergency Medicine Telecommute Medical Review
Concentra Career Choice
Remote
emergency
emergency medicine
telecommute
medical
medical review
medical
health
data
credentialing
board certified
utilization
providers
quality assurance
November 20, 2022
Concentra Career Choice
Fort Collins
Overview:
Are you an accomplished Board Certified physician in Emergency Medicine. Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical reviewstream 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 independent contractor. Preferred candidates will have a CO license.JOB SUMMARY:
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, and performance standards and URAAC guidelines and state regulations
Responsibilities:
MAJOR DUTIES AND RESPONSIBILITIES:
- Reviews medical files and provides 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.
- Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
- Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
- Returns cases in a timely manner with clear concise and complete rationales and documented criteria.
- Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers.
- Attends orientation and training
- Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
- Identifies, critiques, and utilizes 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.
- Provides copies of any criteria utilized in a review to a requesting provider in a timely manner Qualifications:EDUCATION/
CREDENTIALS:
- Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
RELATED EXPERIENCE:
Post-graduate experience in direct patient careJOB-RELATED SKILLS/
COMPETENCIES:
- Demonstrated computer skills, telephonic skills
- Demonstrated ability to perform review services.
PHYSICAL DEMANDS:
- Phone accessability
- Access to a computer to complete reviews
- Ability to complete cases accompanied by a typed report in specified time frames
- Telephonic conferencesThis job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
- 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 and requirements apply to ensure the protection of patient information.
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