Neurologist Medical Review Stream
Location: US-TX-Dallas
Job ID: 300105
Position Category: Medical - Medical Review - UR
Position Type: Contract
Overview
Are you an accomplished Board Certified Neurologist? Preferred candidates will have a TX license. We are seeking flexible and experienced physicians for our medical review stream division. This telecommute role allows you to customize your schedule and caseload within a Monday - Friday work week. You will be compensated on a per case basis as a 1099 independent contractor.
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, performance standards, URAAC guidelines, and state regulations.
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.
- Meets with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
- Maintains proper credentialing and state licenses 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.
- Attends orientation and training.
- Performs other duties as assigned including identifying and responding to quality assurance issues and audits.
- Identifies, critiques, and utilizes current criteria and resources that support sound and objective decision-making 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 or DO with an excellent understanding of network services and managed care.
- Current, unrestricted clinical license(s).
- Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required.
- Must be in active medical practice to perform appeals.
JOB-RELATED EXPERIENCE: Post-graduate experience in direct patient care.
JOB-RELATED SKILLS/COMPETENCIES:
- Demonstrated computer and telephonic skills.
- Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses, and healthcare professionals.
- Must present evidence of current error and omissions liability coverage for job duties.
- Knowledge of current practice standards in specialty.
- Good negotiation and communication skills.
WORKING CONDITIONS/PHYSICAL DEMANDS:
- Phone accessibility.
- 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.
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