Ophthalmologist, Telecommute Medical Review Stream Physician

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

📋 Description

• Evaluate medical files and offer recommendations for utilization review, chart assessments, medical necessity, care appropriateness, return to work, short- and long-term disability, FMLA, group health, and workers’ compensation claims.

• Deliver medical interpretations and decisions regarding the appropriateness of services rendered by healthcare professionals.

• Consult with the Concentra Physician Review Medical Director as necessary concerning quality of care, credentialing, and state licensure issues.

• Ensure the maintenance of proper credentialing, state licenses, certifications, and other job requirements.

• Return cases promptly with clear, concise, and complete rationales along with documented criteria.

• Contact providers by telephone and maintain professional interactions with healthcare professionals.

• Clarify applicable disclaimers and appeal processes to providers.

• Participate in orientation and training sessions.

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

• Identify, evaluate, and utilize current criteria and resources, including national, state, and professional association guidelines, as well as peer-reviewed literature.

• Provide copies of requested review criteria to providers in a timely manner.

⛳️ Requirements

• Board-certified MD or DO.

• An ophthalmologist with board certification from the American Board of Medical Specialties or the American Board of Osteopathic Specialties.

• Current, unrestricted clinical license in Louisiana (or a restricted license with an compliant organizational process).

• Must possess a Louisiana MD license.

• Must be actively practicing medicine to conduct appeals.

• Post-graduate experience in direct patient care.

• Strong understanding of network services, managed care, utilization of services, credentialing, quality assurance, and related 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.

• Current errors and omissions liability coverage related to job duties and activities.

• Managed care orientation.

• Knowledge of contemporary practice standards in ophthalmology.

• Strong negotiation and communication skills.

• Access to phone and computer to complete reviews.

• Ability to finalize cases with typed reports within designated time frames.

• Capacity to manage confidential and sensitive information securely.

🏝️ Benefits

• Flexible schedule and customizable caseload within a Monday–Friday work week and business hours.

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