Physician Case Review Orthopedic Spine Surgeon TX
Are you an accomplished Board Certified Orthopedic Spine Surgeon? 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 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.
- 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 regularly with Medical ReviewStream (MRS) 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
- Attends regular MRS staff physician meetings with MRS Medical Director.
Current, unrestricted clinical licensure and board certification by ABMS or the ABOS. Preferred candidates will have five years post-residency, hands-on patient experience. 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, including disability/veterans