Responsibilities
- Examine medical records and provide recommendations for utilization review, chart reviews, medical necessity, care appropriateness, return to work, short-term and long-term disability, Family and Medical Leave Act (FMLA), group health, and workers' compensation claims.
- Attend meetings with the Concentra Physician Review Medical Director as needed to address care quality, credentialing, and state licensure matters.
- Keep credentialing, state licenses, and any special certifications or requirements current for job performance.
- Complete cases promptly with clear, concise, and complete rationales and documented criteria.
- Contact providers by phone and interact professionally with other health professionals, discussing appropriate disclaimers and the appeal process.
- Participate in orientation and training sessions.
- Carry out other assigned duties, including identifying and responding to quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.
- Identify, critique, and apply current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature to support sound and objective decision-making and rationales in reviews.
- Provide copies of any criteria used in a review to a requesting provider in a timely manner.
Compensation
Compensated on a per case basis
Work Arrangement
Telecommute role with flexible schedule within Monday - Friday business hours
Other
- Telecommute role
- Flexible schedule within Monday - Friday business hours
- Compensated on a per case basis
- Must be in active medical practice to perform appeals
- Must present evidence of current error and omissions liability coverage
- Phone accessibility required
- Access to a computer to complete reviews
- Ability to complete cases accompanied by a typed report in specified time frames
- Telephonic conferences required
- Job requires access to confidential and sensitive information
- Ongoing discretion and secure information management required
