Orthopedic Surgeon, Telecommute Medical Review Stream Physician, MS License

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

📋 Description

• Analyze health claims and medical documentation.

• Deliver medical assessments and decisions regarding the suitability of services.

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

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

• Ensure maintenance of appropriate credentialing, state licenses, certifications, and other essential requirements.

• Return cases promptly with clear, concise, and comprehensive rationales, including documented criteria.

• Engage with providers via telephone, maintaining a professional interaction with healthcare professionals.

• Clarify disclaimers and appeal processes to providers.

• Attend orientation and training sessions.

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

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

• Provide timely copies of review criteria to providers upon request.

⛳️ Requirements

• Board-certified MD or DO Orthopedic Surgeon.

• Active, unrestricted clinical license(s); candidates must possess an MS license.

• 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 is required.

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

• Proven computer proficiency and effective telephonic communication skills.

• Demonstrated capability in providing 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 for job responsibilities and activities.

• Orientation towards managed care.

• Familiarity with contemporary practice standards in the specialty field.

• Strong negotiation and communication skills.

• Access to a phone.

• Access to a computer for completing reviews.

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

• Willingness to participate in telephonic conferences.

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

🏝️ Benefits

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

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