Anesthesiologist Telecommute Medical Review Stream Physician

Concentra•Albuquerque, NM

5d•Remote

About The Position

Concentra is seeking a board-certified anesthesiologist for a telecommute medical review role. The physician reviews health claims and uses clinical expertise to interpret medical information and make decisions about the appropriateness of services provided by other healthcare professionals, consistent with Concentra Physician Review policies and procedures, performance standards, URAAC guidelines, and state regulations. The position requires an active medical practice, averaging 20 hours per week seeing patients. This is a per-case compensated 1099 independent contractor role. The physician can customize their schedule and caseload within a Monday–Friday work week and business hours. Candidates must have a New Mexico MD license. The work requires access to a phone and computer, timely completion of cases with typed reports, and participation in telephonic conferences. The role involves handling confidential and sensitive information and requires secure information management.

Requirements

Board-certified MD or DO; certification must be by the American Board of Medical Specialties or the American Board of Osteopathic Specialties.
Current, unrestricted clinical license(s), or a restricted license for which the organization can ensure job functions do not violate state-imposed restrictions; candidates must have a New Mexico MD license.
Must be in active medical practice to perform appeals; the role specifies an average of 20 hours per week seeing patients.
Post-graduate experience in direct patient care.
Excellent understanding of network services, managed care, appropriate utilization of services and credentialing, quality assurance, and development of policies supporting these services.
Demonstrated computer and telephonic skills and ability to perform review services.
Ability to work with regulatory agency representatives, carriers, employers, nurses, and healthcare professionals.
Ability to provide medical direction without a financial conflict of interest.
Evidence of current errors and omissions liability coverage for job duties and activities performed.
Managed care orientation and knowledge of current practice standards in the specialty.
Good negotiation and communication skills.
Access to a phone and a computer to complete reviews; ability to complete cases with typed reports within specified time frames and participate in telephonic conferences.
Ability to handle confidential and sensitive information with ongoing discretion and secure information management.

Responsibilities

Review medical files and provide recommendations concerning utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short- and long-term disability, FMLA, group health, and workers’ compensation claims.
Meet with the Concentra Physician Review Medical Director when required to discuss quality of care, credentialing, and state licensure issues.
Maintain proper credentialing, state licenses, and any special certifications or requirements necessary to perform the job.
Return cases in a timely manner with clear, concise, and complete rationales and documented criteria.
Contact providers by telephone and interact professionally with other health professionals; discuss applicable disclaimers and the appeal process with providers.
Attend orientation and training.
Perform other assigned duties, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
Identify, critique, and use current criteria and resources, including national, state, and professional association guidelines and peer-reviewed literature, to support sound and objective review decisions and rationales.
Provide copies of criteria used in a review to requesting providers in a timely manner.
Protect patient data and handle sensitive information in accordance with applicable data protection principles, policies, and requirements.