Spine Surgeon Telecommute Medical Review

Concentra - Newark, NJ

Full-time - Senior

Remote - Newark, NJ

Ambulatory Health Care Services

About the position

The Spine Surgeon Telecommute Medical Review position at Concentra is designed for experienced, board-certified spine or neurosurgeons who are looking for a flexible work-life balance. This role allows physicians to review health claims and provide medical interpretations while working remotely. The position offers the opportunity to customize schedules and caseloads within a Monday to Friday work week, compensating on a per-case basis as independent contractors. Candidates must hold a valid New Jersey medical license and be actively practicing medicine.

Responsibilities

• Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, and return to work.
• Meets with Concentra Physician Review Medical Director to discuss quality of care and credentialing issues when required.
• Maintains proper credentialing, state licenses, and any special certifications necessary for 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.
• Attends orientation and training sessions.
• Identifies and responds to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits as assigned.
• Critiques and utilizes current criteria and resources to support sound decision-making in reviews.
• Provides copies of any criteria utilized in a review to a requesting provider in a timely manner.

Requirements

• Board certified MD or DO with an excellent understanding of network services and managed care.
• Current, unrestricted clinical license(s) in New Jersey.
• Board certification by American Board of Medical Specialties or American Board of Osteopathic Specialties is required.
• Post-graduate experience in direct patient care is necessary.
• Demonstrated computer and telephonic skills.
• Ability to work with various professionals including regulatory agencies, carriers, and healthcare professionals.
• Evidence of current error and omissions liability coverage for job duties.

Nice-to-haves

• Managed care orientation.
• Knowledge of current practice standards in specialty.
• Good negotiation and communication skills.

Benefits

• Flexible work schedule.
• Compensation on a per-case basis as a 1099 independent contractor.