Physician Psychiatrist Telecommute Medical ReviewStream
Location
US-CO-Denver
Job ID
285369
Pos. Category
Medical - Medical Review - UR
Pos. Type
Contract
Overview
Are you an accomplished Board Certified Psychiatrist? 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 1099 independent
contractor. Candidates must have a CO license and a Level 1 or Level 2
Accreditation.
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:
-Current, unrestricted clinical license(s) (or if the license is
restricted, the organization has a process to ensure job functions do not
violate the restrictions imposed by the State Board);
-Board certification by American Board of Medical specialties or American
Board of Osteopathic Specialties is required for MD or DO reviewer.
-Must be in active medical practice to perform appeals
JOB-RELATED EXPERIENCE:
Post-graduate experience in direct patient care
JOB-RELATED SKILLS/COMPETENCIES:
-Demonstrated computer skills, telephonic skills
-Demonstrated ability to perform review services.
-Ability to work with various professionals including members of regulatory
agencies, carriers, employers, nurses and health care professionals.
-Medical direction shall also be provided consistent with the requirement that
the physician advisor shall not have a financial conflict of interest
-Must present evidence of current error and omissions 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 accessability
-Access to a computer to complete reviews
-Ability to complete cases accompanied by a typed report in specified time
frames
-Telephonic conferences
This job requires access to confidential and sensitive information,
r quiring ongoing discretion and secure information management.
Concentra is an Equal Opportunity Employer M/F/Disability/Veteran
Concentra's Data Protection Commitment
* Concentra is committed to protect patient data and to ensure privacy of
personal and medical information.
*... For full info follow application link.
EOE, including disability/veterans