Physician Advisor Wanted for Concentra Physician Review
Are you an accomplished Board Certified Anesthesiologist, Orthopedic Surgeon, or a Critical Care Provider? Certified in Pain Management, Occupational Medicine, Family Medicine or Internal Medicine? Are you passionate about your work/life balance? We are looking for an engaging and motivated Physician Advisor, and Concentra is excited to meet you. We are recruiting a dynamic and creative Physician for our Review Division. We ask our preferred Physician to have an active TX, or CA license.
Building upon successful clinical accomplishments, reviewing health claims and providing medical interpretation will play a significant part in your career path with Concentra.
A creative and innovative forward-thinking clinician will align well with Concentra Physician Review policies, procedures, and performance standards, in addition to URAAC guidelines and state regulations.
- Assists Medical Director with recruiting, credentialing, training and educating clinical reviewers, CPR staff and customers quality assurance.
- Reviews medical files and provides favorable recommendations for utilization review, chart reviews, and return to work. Acknowledge and recommend options for short and long-term disability, Federal Management Leave Act, Group health, and workers compensation claims.
- You will meet and brainstorm regularly with the Medical Director to discuss quality of care ideas, credentialing, and licensure issues.
- Maintain state licensure and any special certifications or requirements necessary to perform the job.
- Expediting a quick turnaround with cases, while providing clear concise and complete evaluations in all documented criteria.
- Contacts colleagues when necessary to identify appropriate disclaimers and appeal processes with counterparts.
- Masters other duties as assigned, including identifying and responding to quality assurance issues, complaints, and regulatory issues while handling depositions, as well as court appearances or audits.
- Identifies, critiques, monitors, and gauges current benchmarks for professional association guidelines and literature, which supports sound and objective decision-making for reviews.
- Performs and participates in Quality Assurance activities such as quality check reviews of physician charts. Navigates tracking and trending of results and ongoing quality improvement.
- Compose and deliver educational seminars which include orientation programs and newsletters for healthcare advisors.
- Educates, guides and leads nurses, adjusters, and CPR staff by developing conferences for CPR customers and carriers and TCM/UR staff.
- Selects new reviewers and facilitates all credentialing.
- Produces instruction and training manuals to educate reviewers.
- Identifies and reviews current guidelines, including peer-reviewed literature.
- Partners with account representatives and sales teams with creative and fresh ideas for new business while maintaining current customers.
Current, unrestricted clinical licensure and board certified by ABMS or the ABOS. We want you to participate in a successful medical practice to perform appeals.
Working with various peers, including members of regulatory agencies, carriers, employers, nurses and health care providers is key to the success of this opportunity.
The Physician Adviser acknowledges he/she shall not have a financial conflict of interest. You have the privilege to present evidence of current error and omissions liability coverage, for job duties and activities performed. You will also have an opportunity to instruct managed care orientation. Exceptional negotiation and interpersonal skills complete part of this dynamic package.
WORKING CONDITIONS/PHYSICAL DEMANDS:
-Access to a computer to complete reviews
-Ability to complete cases accompanied by a typed report in specified time frames
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Concentra is an Equal Opportunity Employer M/F/Disability/Veteran