Physical Medicine & Rehabilitation Telecommute Medical Review Stream Physician

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

📋 Description

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

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

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

• Promptly return cases with clear, comprehensive rationales and documented criteria.

• Communicate with providers via telephone and maintain professional interactions with other healthcare professionals.

• Explain disclaimers and the appeal process to providers.

• Participate in orientation and training sessions.

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

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

• Timely provide requested copies of review criteria to providers.

⛳️ Requirements

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

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

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

• Must be actively practicing medicine to handle appeals.

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

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

• Proven computer and telephonic skills.

• Demonstrated capability to perform review services effectively.

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

• Current errors and omissions liability coverage related to job responsibilities and activities.

• Familiarity with managed care principles.

• Knowledge of current practice standards in the specialty.

• Strong negotiation and communication skills.

• Access to a phone and a computer to complete reviews.

• Ability to produce typed reports and complete cases within designated time frames.

• Capability to engage in telephonic conferences.

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

🏝️ Benefits

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

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