Orthopedic Surgeon – Telecommute Medical Review Stream Physician

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

📋 Description

• Evaluate health claims and deliver medical insights and determinations on the appropriateness of services.

• Analyze medical records and offer recommendations for utilization review, chart assessments, medical necessity, care appropriateness, return to work, disability, FMLA, group health, and workers’ compensation claims.

• Collaborate with the Concentra Physician Review Medical Director on matters concerning quality of care, credentialing, and state licensing issues.

• Ensure compliance with credentialing, state licensing, certifications, and other job requirements.

• Return cases in a timely manner with comprehensive rationales and documented criteria.

• Communicate with providers via telephone to discuss disclaimers and appeals processes.

• Participate in orientation and training sessions.

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

• Recognize, evaluate, and utilize contemporary criteria, guidelines, and peer-reviewed literature in evaluations.

• Promptly provide requested review criteria copies to providers.

⛳️ Requirements

• Board certified MD or DO.

• Possession of a current, unrestricted clinical license; candidates must hold a California license.

• Board certification by the American Board of Medical Specialties or 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.

• Knowledge of network services, managed care, service utilization, credentialing, quality assurance, and policy formulation.

• 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 conflicts of interest.

• Current errors and omissions liability coverage is necessary.

• Orientation towards managed care.

• Familiarity with current practice standards in the specialty area.

• Strong negotiation and communication abilities.

• Access to a phone and computer to complete reviews.

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

• Willingness to participate in telephonic conferences.

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

🏝️ Benefits

• Flexible scheduling and caseload within a Monday–Friday workweek and business hours.

• Work/life balance.

• Telecommuting options available.

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

• Orientation and training provided.

• Support for growth and well-being.

• Equal opportunity employment.