Examine medical records and offer 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.
When necessary, meet with the Concentra Physician Review Medical Director to address quality of care, credentialing, and state licensure matters.
Maintain current credentialing, state licenses, and any special certifications or requirements needed for the job.
Return cases promptly with clear, concise, and complete rationales and documented criteria.
Contact providers by phone and interact professionally with other healthcare professionals.
Explain appropriate disclaimers and the appeal process to providers.
Participate in orientation and training sessions.
Perform other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.
Identify, critique, and use 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.

Compensated on a per case basis as a 1099 independent contractor

Telecommute role

Telecommute role
Monday - Friday work week within business hours
Must have MD license from IL
Must be in active medical practice to perform appeals
Phone accessibility required
Access to a computer to complete reviews required
Ability to complete cases accompanied by a typed report in specified time frames
Telephonic conferences required
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Concentra Health Services, Inc. is hiring an Orthopedic Surgeon Telecommute Medical Review Stream Physician

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