What are the responsibilities and job description for the Neurologist Medical Review Stream position at Concentra, Inc.?
Overview
Are you an accomplished Board Certified Neurologist in one of the below specialties? Preferred candidates will have a TX license.
Are you passionate about your work / life balance? We are seeking flexible and experienced physicians for our medical review stream 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.
- Maintains 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.
Qualifications
EDUCATION / CREDENTIALS :
JOB-RELATED EXPERIENCE : Post-graduate experience in direct patient care.
JOB-RELATED SKILLS / COMPETENCIES :
WORKING CONDITIONS / PHYSICAL DEMANDS :
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Additional Data
This position is an independent contractor role for Concentra.
Concentra is an Equal Opportunity Employer, including disability / veterans.
J-18808-Ljbffr
