Physician Reviewer Multiple Specialties - Indiana and Nevada
About The Position
Federal Hearings and Appeals Services (FHAS) is a URAC-accredited Independent Medical Review Organization (IRO) with Health Utilization Management (HUM) accreditation. For the past 30 years, FHAS has provided external peer review services to healthcare organizations, government agencies, insurance companies, and legal entities. FHAS is currently expanding its elite panel of physicians licensed in the state of Indiana and Nevada to assist with independent review claims and appeals in any of the following specialties: Addiction Medicine, Allergy & Immunology, Anesthesiology, Cardiovascular Disease, Child & Adolescent Psychiatry, Chiropractic Medicine, Dentist, Dermatology, Emergency Medicine, Endocrinology, Diabetes, & Metabolism, Family Medicine, Gastroenterology, Internal Medicine, Interventional Cardiology, Interventional Radiology & Diagnostic Radiology, Medical Genetics & Genomics, Medical Oncology, Nephrology, Neurological Surgery, Neurology, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Pain Medicine, Pathology, Pediatrics, Pediatric Cardiology, Pediatric Critical Care Medicine, Developmental-Behavioral Pediatrics, Pediatric Emergency Medicine, Pediatric Gastroenterology, Pediatric Nephrology, Physical Medicine & Rehabilitation, Plastic Surgery, Psychiatry, Psychology PhD, Radiation Oncology, Radiology, Rheumatology, Sleep Medicine, Thoracic & Cardiac Surgery, Transplant Hepatology, Undersea & Hyperbaric Medicine Description Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA). Reviews and analyzes Federal and State laws, regulations, and applicable policy guides Completes and evaluates the review process in a regulatory timeframe.
Requirements
- Successful completion of a Residency or Fellowship Program
- Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
- License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
- License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
- For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
- Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
- 5-years or more post graduate clinical experience in direct patient care
- Experience providing direct patient care within the past 3 years, if performing external reviews
Responsibilities
- Responsible for reviewing medical case files and making medical determinations.
- Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
- Completes and evaluates the review process in a regulatory timeframe.
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
