Physical Medicine & Rehabilitation Medical Review Stream Physician

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

📋 Description

• Evaluate health claims and medical records.

• Offer medical interpretation and judgments regarding the suitability of services.

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

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

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

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

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

• Clarify disclaimers and the appeal process to providers.

• Participate in orientation and training sessions.

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

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

• Provide requested review criteria copies to providers promptly.

⛳️ Requirements

• Board certified MD or DO in Physical Medicine & Rehabilitation.

• Current, unrestricted clinical license(s); candidates must possess a California license.

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

• Must be actively practicing medicine to handle appeals.

• Post-graduate experience in direct patient care.

• 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.

• Evidence of current errors and omissions liability coverage for job responsibilities and activities performed.

• Managed care orientation.

• Familiarity with current practice standards in the specialty.

• Strong negotiation and communication skills.

• Access to a phone.

• Access to a computer for completing reviews.

• Ability to finalize cases with a typed report within designated timeframes.

• Capability to participate in telephonic conferences.

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

🏝️ Benefits

• Telecommuting opportunity.

• 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.