Orthopedic Surgeon – Telecommute Medical Review

🔥 1 hour ago

🌶️ New Mexico – Remote

infoinfo

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

Where this job comes from

Posted on Concentra's careers page, not through a job board

First seen by Remote Rocketship 1 hour ago

Logo of Concentra

Concentra

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🧬 Biotechnology

Healthcare • Healthcare Insurance • Biotechnology

Concentra is a leading provider of healthcare services, focusing on rehabilitation and recovery for patients with critical illnesses and injuries. With an extensive network of inpatient rehabilitation hospitals and outpatient centers across the United States, Concentra is committed to delivering exceptional patient care that promotes healing and quality of life. Their team of over 45,000 healthcare professionals works collaboratively to design personalized treatment plans aimed at restoring function and facilitating a smooth transition from hospital to home.

📋 Description

• Review health claims and medical files for utilization review, chart reviews, medical necessity, appropriateness of care, return to work, short- and long-term disability, FMLA, group health, and workers’ compensation claims • Provide medical interpretation, recommendations, and decisions regarding appropriateness of services • Meet with the Concentra Physician Review Medical Director regarding quality of care, credentialing, and state licensure issues when required • Maintain credentialing, state licenses, special certifications, and other job requirements • Return cases promptly with clear, complete rationales and documented criteria • Contact providers by telephone and interact with healthcare professionals • Explain disclaimers and appeal processes to providers • Attend orientation and training • Identify and respond to quality assurance, complaints, regulatory, deposition, court appearance, and audit matters • Identify, critique, and use current criteria, guidelines, and peer-reviewed literature to support objective review decisions • Provide requested copies of review criteria to providers promptly

🎯 Requirements

• Board certified MD or DO • Current, unrestricted clinical license(s); candidates must have a New Mexico license • Board certification by the American Board of Medical Specialties or American Board of Osteopathic Specialties required for MD or DO reviewer • Must be in active medical practice to perform appeals • Post-graduate experience in direct patient care • Excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance, and policy development • Demonstrated computer skills and telephonic skills • Demonstrated ability to perform review services • Ability to work with regulatory agencies, carriers, employers, nurses, and healthcare professionals • Current error and omissions liability coverage for job duties and activities • Managed care orientation • Knowledge of current practice standards in specialty • Good negotiation and communication skills • Access to a phone and computer to complete reviews • Ability to complete cases with typed reports within specified time frames • Ability to participate in telephonic conferences • Ongoing discretion and secure management of confidential and sensitive information

🏖️ Benefits

• Flexible schedule and customizable caseload within a Monday–Friday work week and business hours • Compensation on a per-case basis • 1099 independent contractor arrangement • Telecommute work arrangement • Orientation and training

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