Orthopedic Hand Surgeon Physician Telecommute Medical ReviewStream

Job Id
128305
Job Location
Austin, TX
Employment Type
Contract
Industry
Health Care
Concentra
20200512T050735Z
Overview

Are you an accomplished Board Certified Orthopedic Hand Surgeon?  Are you passionate about your work/life balance? We are seeking a flexible and experienced physician 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.  Preferred candidates will have a Texas license.

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.
-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:
- Minimum five years 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, requiring 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.
*    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.

Benefits

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.

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