Orthopedic Surgeon – Telecommute Medical Review

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

📋 Description

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

• Deliver medical interpretations, recommendations, and decisions concerning the appropriateness of services.

• Collaborate with the Concentra Physician Review Medical Director regarding quality of care, credentialing, and state licensure issues as needed.

• Uphold credentialing, state licenses, special certifications, and other job prerequisites.

• Return cases promptly with thorough, clear rationales and documented criteria.

• Communicate with providers via telephone and engage with healthcare professionals.

• Clarify disclaimers and appeal processes to providers.

• Participate in orientation and training sessions.

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

• Identify, evaluate, and utilize current criteria, guidelines, and peer-reviewed literature to justify objective review decisions.

• Promptly provide requested copies of review criteria to providers.

⛳️ Requirements

• MD or DO with board certification.

• Valid, unrestricted clinical license(s); candidates must possess a New Mexico license.

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

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

• Post-graduate experience in direct patient care is required.

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

• Proven computer and telephonic communication skills.

• Demonstrated capability to perform review services effectively.

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

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

• Familiarity with managed care principles.

• Knowledge of contemporary practice standards in the specialty.

• Strong negotiation and communication abilities.

• Access to a phone and computer for completing reviews.

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

• Willingness to participate in telephonic conferences.

• Commitment to maintaining discretion and secure management of confidential and sensitive information.

🏝️ Benefits

• Flexible scheduling and customizable caseloads within a Monday–Friday work week and business hours.

• Per-case compensation structure.

• 1099 independent contractor arrangement.

• Opportunity for telecommuting.

• Orientation and training provided.