Responsibilities
- Examine medical records and offer guidance on utilization management, chart evaluations, medical necessity, care appropriateness, return-to-work decisions, short-term and long-term disability, Family and Medical Leave Act (FMLA) claims, group health, and workers' compensation cases.
- Engage with the Concentra Physician Review Medical Director as needed to address care quality, credentialing, and state licensing matters.
- Keep current credentials, state licenses, and any specialized certifications or requirements essential for the role.
- Complete case reviews promptly, providing clear, concise, and thorough rationales supported by documented criteria.
- Contact healthcare providers by phone and interact professionally with other health professionals, explaining appropriate disclaimers and the appeal process.
- Participate in orientation and training sessions.
- Carry out additional tasks as assigned, including identifying and addressing quality assurance issues, complaints, regulatory concerns, 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 and objective decision-making in reviews.
- Supply copies of any criteria used in a review to requesting providers in a timely manner.
Compensation
Compensated on a per case basis
Work Arrangement
Telecommute role with flexible schedule within Monday-Friday business hours
