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Neurologist Telecommute Medical Review Stream

Remote: 
Full Remote
Contract: 
Full time
Experience: 
Mid-level (2-5 years)
Work from: 
New Jersey (USA), United States

Offer summary

Qualifications:

Board Certified Neurologist with NJ license, Active medical practice post-grad experience.

Key responsabilities:

  • Review health claims and provide recommendations
  • Maintain credentialing, attend trainings, return cases timely
  • Utilize current criteria for objective decision making
Concentra logo
Concentra XLarge https://www.concentra.com/
10001 Employees
About Concentra
WHO WE ARE: Concentra is the leader in occupational health with 40+ years of improving the health of America's workforce, one patient at a time. More than 11,000 Concentra colleagues provide occupational medicine, onsite health care, physical therapy, and telemedicine services from nearly 520 medical centers and 130+ onsite clinics nationwide. THE CONCENTRA WAY: Living out our Mission, Vision, and Values to improve the patient experience, redefine health care, and help people achieve lifelong well-being. OUR MISSION: Improving the health of America’s workforce, one patient at a time. OUR VISION: Every person is treated the Concentra Way: quality clinical care and a positive customer experience from welcoming, respectful, and skillful colleagues. OUR VALUES: A healing focus, a selfless heart, and a tireless resolve. Our goal at Concentra is living out our Mission, Vision, and Values to improve the patient experience, redefine health care, and help people achieve lifelong well-being, SCAM ALERT: Concentra has been informed that scammers are using our name to scam individuals who believe they are applying for an opportunity with Concentra or receiving a job offer from Concentra. These scammers can be very convincing, going so far as to steal the profile pictures from our actual recruiters from their LinkedIn profiles and using email addresses that contain the word ‘Concentra’ such as ‘@ConcentraCareers’ or ‘@ConcentraJobs’ or '@concentracareerdesk.' The scammers will typically ask you to send money at some point (for equipment, training, or a uniform, etc.). A LEGITIMATE CONCENTRA RECRUITER OR HIRING MANAGER WILL NEVER ASK YOU TO SEND US MONEY. Also, you will never receive a job offer from us if we have not verbally interviewed you. For more information on recruiting scams or to report a recruiting scam visit the website of the Federal Trade Commission at https://www.consumer.ftc.gov/articles/0243-job-scams.
See more Concentra offers

Job description

Are you an accomplished Board Certified Neurologist ? Candidates must have a NJ license.

Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical reviewstream division. This telecommute role provides the ability for you to customize your schedule and caseload within a Monday - Friday work week and within business hours. Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor.

Job Summary

Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations.

Responsibilities

MAJOR DUTIES AND RESPONSIBILITIES:

  • Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims.
  • Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
  • Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
  • Returns cases in a timely manner with clear concise and complete rationales and documented criteria.
  • Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers.
  • Attends orientation and training
  • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
  • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer reviewed literature that support sound and objective decision making and rationales in reviews.
  • Provides copies of any criteria utilized in a review to a requesting provider in a timely manner

Education/Credentials

 Qualifications

  • Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
  • Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board);
  • Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
  • Must be in active medical practice to perform appeals

Job-related Experience

Post-graduate experience in direct patient care

Job-related Skills/Competencies

  • Demonstrated computer skills, telephonic skills
  • Demonstrated ability to perform review services.
  • Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals.
  • Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest
  • Must present evidence of current error and omissions liability coverage for job duties and activities performed
  • Managed care orientation
  • Knowledge of current practice standards in specialty
  • Good negotiation and communication skills

Working Conditions/Physical Demands

  • Phone accessability
  • Access to a computer to complete reviews
  • Ability to complete cases accompanied by a typed report in specified time frames
  • Telephonic conferences

This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Concentra is an Equal Opportunity Employer M/F/Disability/Veteran

Concentra's Data Protection Commitment

  • Concentra is committed to protect patient data and to ensure privacy of personal and medical information.
  • Every Concentra colleague has the responsibility to adhere to data protection principles.
  • If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

Additional Data

 This position is an independent contractor role for Concentra.

Concentra is an Equal Opportunity Employer, including disability/veterans

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Industry :
Health Care
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Hard Skills

Utilization ManagementMedical NecessityNeurologyMedical InterpretationManaged CareMedical Licensing (Health Law)Negotiation StrategiesClinical Practices

Other Skills

  • Time Management
  • Communication
  • Social Skills
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