Medical Director of Utilization Review Cleveland, OH Part Time

Job Id
162074
Job Location
Cleveland, OH
Employment Type
Per Diem
Industry
Health Care
Concentra
20210607T184547Z
Overview

Concentra, one of the largest health care companies in the nation, is looking for an On-site Physician for Part-time Uitilization Review . Your patients, as well as your medical and support team, will look to you for your excellent problem solving and leadership skills. As a Concentra on, you will be reviewing medical files and providing 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.  The service you provide will make a tremendous difference in the lives of those who look to us for care and comfort.

At Concentra, you not only are rewarded by helping thousands of patients feel better each year but also by the recognition you receive as a leader within the company. Your ideas will be heard. In addition to patient care, every Physician has the opportunity to make an impact on procedures and policies at the Center. Take a closer look at Concentra.

WORK ENVIRONMENT AND CONDITIONS:

  • On-site Utilization Review
  • Working with the City of Cleveland treating employees of municipalities.
  • Injury care for firefighters/ police
  • 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
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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
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Qualifications

EDUCATION/CREDENTIALS

  • Board Certification / Eligibility highly preferred
  • Occupational Medicine experience preferred, but we are willing to train otherwise qualified candidates in this area of medicine
  • Licensure requirements of the state of jurisdiction
  • Graduate of accredited MD or DO program of accredited university
  • Unrestricted DEA license for state of jurisdiction
  • Must be eligible to participate in Medicare
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Benefits

JOB-RELATED SKILLS/COMPETENCIES:

  • Demonstrates computer skills.
  • Demonstrates ability to perform review services.
  • Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals.
  • History with utilization review or case review

BENEFITS SUMMARY:

  • Training Provided in Our World-Class Occupational Medicine Process Management Model
  • Medical Malpractice Coverage
  • 401(k) with Employer Match

If you’re looking for an organization that cares for your growth and well-being as much it does its patients, consider Concentra.

This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Concentra is an Equal Opportunity Employer, including disability/veterans

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Concentra is an Equal Opportunity Employer, including disability/veterans


We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, sexual orientation, gender identity, disability or medical or veteran status in accordance with federal law. In addition, Concentra Inc. complies with applicable state and local laws prohibiting discrimination in employment in every jurisdiction in which it maintains facilities.

Talk to a Recruiter

Adam_Morris
Adam Morris
Phone: 4699346740