Physician Orthopedic Surgeon Telecommute Medical Review

Are you an accomplished Board Certified Orthopaedic Surgeon? Are you passionate about your work/life balance? We are seeking flexible and experienced physicians 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 TX license.

JOB SUMMARY:
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.

MAJOR DUTIES AND RESPONSIBILITIES:

• 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.
• Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
• Provides copies of any criteria utilized in a review to a requesting provider in a timely manner
• Returns cases in a timely manner with clear concise and complete rationales and documented criteria.
• Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
• Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
• Attends orientation and training
• 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.
• Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers.

EDUCATION/CREDENTIALS:

• 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);
• Must be in active medical practice to perform appeals
• 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.
• Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.

JOB-RELATED EXPERIENCE:
Post-graduate experience in direct patient care

JOB-RELATED SKILLS/COMPETENCIES:

• Good negotiation and communication skills
• Managed care orientation
• Demonstrated computer skills, telephonic skills
• Demonstrated ability to perform review services.
• Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest
• Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals.
• Must present evidence of current error and omissions liability coverage for job duties and activities performed
• Knowledge of current practice standards in specialty

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Phone accessability
• Ability to complete cases accompanied by a typed report in specified time frames
• Telephonic conferences
• Access to a computer to complete reviews

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

• Every Concentra colleague has the responsibility to adhere to data protection principles.
• Concentra is committed to protect patient data and to ensure privacy of personal and medical information.
• If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

This position is an independent contractor role for Concentra.

Select Medical is committed to having a workforce that reflects diversity at all levels and is an equal opportunity employer. Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, sexual orientation, gender identity, marital status, ancestry, physical or mental disability, veteran status, or any other characteristic protected under applicable law.