Ophthalmologist Telecommute Medical Review Stream Physician

Overview

Are you an accomplished Board Certified Ophthalmologist 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 a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor.

Candidates must have a Louisiana 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

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 :

Post-graduate experience in direct patient care

JOB-RELATED SKILLS / COMPETENCIES :

WORKING CONDITIONS / PHYSICAL DEMANDS :

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

Concentras Data Protection Commitment

Additional Data

Concentra is an Equal Opportunity Employerincluding disability / veterans

Key Skills

EMR Systems,Post Residency Experience,Occupational Health Experience,Pain Management,SOAP,Primary Care Experience,Medical Management,Suturing,Workers' Compensation Law,Pharmacy Residency,Botox Experience,Epic

Employment Type : Unclear

Experience : years

Vacancy : 1