Examine medical records and offer guidance on utilization management, chart evaluations, medical necessity, care appropriateness, return-to-work assessments, short- and long-term disability, Family and Medical Leave Act (FMLA) cases, group health, and workers' compensation claims.
Participate in meetings with the Physician Review Medical Director as needed to address care quality, credentialing, and state licensing matters.
Keep current all professional credentials, state licenses, and any specialized certifications or requirements essential for the role.
Complete assigned cases promptly, providing clear, concise, and thorough justifications along with documented criteria.
Contact healthcare providers by phone and interact professionally with other medical professionals.
Explain appropriate disclaimers and the appeals process to providers.
Attend orientation and training sessions.
Carry out additional duties as assigned, including identifying and addressing quality assurance concerns, complaints, regulatory issues, depositions, court appearances, or audits.
Identify, evaluate, and apply current criteria and resources—such as national, state, and professional association guidelines and peer-reviewed literature—to support sound, objective decision-making and rationales in reviews.
Provide copies of any criteria used in a review to requesting providers in a timely manner.

Compensated on a per case basis as a 1099 independent contractor

Telecommute

Must have phone accessibility.
Must have access to a computer to complete reviews.
Ability to complete cases accompanied by a typed report within specified time frames.
Must participate in telephonic conferences.
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
This position is an independent contractor role for Concentra.

Concentra Health Services, Inc. is hiring a Neurosurgeon Telecommute Medical Review

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