Orthopedic Surgeon, Telecommute Medical Review Stream Physician

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

📋 Description

• Evaluate health claims and medical documentation.

• Deliver medical insights and decisions concerning the appropriateness of services.

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

• Meet with the Concentra Physician Review Medical Director as necessary to discuss care quality, credentialing, and state licensure matters.

• Ensure proper credentialing, state licenses, certifications, and compliance with other requirements.

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

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

• Discuss disclaimers and appeal procedures with providers.

• Participate in orientation and training sessions.

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

• Identify, analyze, and apply current criteria, national/state/professional guidelines, and peer-reviewed literature.

• Provide requested review criteria to providers promptly.

⛳️ Requirements

• Board certified MD or DO.

• Current, unrestricted clinical license(s); candidates must possess an MD license from Illinois.

• Board certification from the American Board of Medical Specialties or American Board of Osteopathic Specialties.

• Must be actively practicing medicine to handle appeals.

• Post-graduate experience in direct patient care.

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

• Proven computer skills and effective telephonic communication abilities.

• Demonstrated capacity to perform review services.

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

• No financial conflict of interest.

• Proof of current errors and omissions liability coverage.

• Familiarity with managed care principles.

• Knowledge of current practice standards in the specialty.

• Strong negotiation and communication skills.

• Access to a telephone.

• Access to a computer for completing reviews.

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

• Capacity to engage in telephonic conferences.

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

🏝️ Benefits

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

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