Medical Director of Utilization Review Cleveland, OH Part Time
More time for your patients and more time for you. It’s time to learn more about careers at Concentra.
Concentra, one of the largest health care companies in the nation, is looking for an On-site Physician for Part-time or Full-time Utilization Review. You will rely on your clinical background, to review health claims provide medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with LEO and NFPA, by Concentra policies, procedures, and performance standards and state regulations.
Ensure the delivery of exceptional customer service by putting all customers (internal and external) first and displaying:
- A healing focus
- A selfless heart
- A tireless resolve
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.
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.
- Attends regular meetings with the Safety Medical Unit Manager , police and fire chief and DMO to review cases
- 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 patients and interacts with other health professionals in a professional manner
- Attends orientation and trainin
- 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.
- Board certification MD or DO
- Must be Board certified by American Board of Medical specialties or American Board of Osteopathic Specialties
- Has an excellent understanding of the Ohio workers compensation, Job duties of safety forces personnel, quality assurance and the development of policies that support these services.
- Unrestricted DEA license for state of jurisdiction
- Must be eligible to participate in Medicare
- Current, unrestricted clinical license
- A minimum of two years clinical experience in current practice area
- Demonstrated computer skills, telephonic skills
- Demonstrated ability to perform review services.
- Ability to work with various professionals including members of regulatory agencies, carriers, employers, unions 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
- Managed care orientation
- Knowledge of current practice standards in specialty
- Good negotiation and communication skills
WORKING CONDITIONS/PHYSICAL DEMANDS:
- Phone accessibility
- A computer will be provided to complete reviews
- Ability to complete cases accompanied by a typed report in specified time frames
- Telephonic conferences
- 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