Anesthesiologist, Telecommute, Medical Review Stream Physician

This is a fully remote position, open to applicants in New Mexico.

📋 Description

• Evaluate health claims and offer medical insights and determinations regarding the appropriateness of services rendered by healthcare professionals.

• Analyze medical records and provide recommendations for utilization reviews, chart assessments, medical necessity evaluations, care appropriateness, return-to-work assessments, and short- and long-term disability, FMLA, group health, and workers’ compensation claims.

• Collaborate with the Concentra Physician Review Medical Director on quality of care, credentialing, and state licensure concerns as necessary.

• Ensure proper maintenance of credentialing, state licenses, certifications, and other essential qualifications.

• Return cases in a timely manner with clear, concise, and well-documented rationales and criteria.

• Communicate with providers via telephone to discuss disclaimers and the appeal process.

• Participate in orientation and training sessions.

• Identify and address quality assurance concerns, complaints, regulatory issues, depositions, court appearances, and audits.

• Recognize, assess, and utilize current criteria, national and state guidelines, professional association standards, and peer-reviewed literature.

• Timely provide requested copies of review criteria to providers.

⛳️ Requirements

• Board certified MD or DO.

• Current, unrestricted clinical license(s), or a restricted license that allows for the job functions.

• Board certification from the American Board of Medical Specialties or the American Board of Osteopathic Specialties is required for MD or DO reviewers.

• Must be actively engaged in medical practice to handle appeals.

• Post-graduate experience in direct patient care.

• New Mexico MD license.

• Average of 20 hours per week in active practice seeing patients.

• Strong understanding of network services and managed care, service utilization, credentialing, quality assurance, and policy development.

• Proven computer and telephonic skills.

• Demonstrated capability to perform review services.

• Ability to collaborate with regulatory agencies, carriers, employers, nurses, and healthcare professionals.

• No financial conflict of interest for physician-advisor medical direction.

• Current errors and omissions liability coverage for job responsibilities and activities.

• Familiarity with managed care principles.

• Knowledge of current practice standards in the specialty area.

• Strong negotiation and communication skills.

• Access to phone and computer to complete reviews.

• Capability to finalize cases with typed reports within designated timeframes.

• Ability to participate in telephonic conferences.

• Ongoing discretion and secure management of confidential and sensitive information.

🏝️ Benefits

• Flexible schedule and caseload within a Monday to Friday workweek during business hours.

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