Spine Medical Review Physician

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

📋 Description

• Evaluate health claims and medical records, offering medical insights and making decisions regarding the suitability of services.

• Deliver recommendations for utilization reviews, chart assessments, medical necessity, care appropriateness, return-to-work protocols, short- and long-term disability considerations, FMLA, group health, and workers' compensation claims.

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

• Ensure the maintenance of proper credentialing, state licenses, special certifications, and other necessary requirements.

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

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

• Participate in orientation and training sessions.

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

• Analyze, assess, and apply current criteria, guidelines, and peer-reviewed literature to substantiate objective review decisions.

• Timely supply requested review criteria copies to providers.

⛳️ Requirements

• Must possess a board certification as an MD or DO.

• Specialty in Spine Surgery is required.

• Hold a current, unrestricted clinical license; candidates must have a New Mexico license.

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

• Must be actively engaged in medical practice to handle appeals.

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

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

• Proven computer and telephonic competencies.

• Demonstrated capability to perform review services.

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

• Must provide proof of current errors and omissions liability coverage.

• Familiarity with managed care principles.

• Knowledge of contemporary practice standards in the specialty field.

• Strong negotiation and communication abilities.

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

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

• Ability to manage confidential and sensitive information with ongoing discretion and secure information handling.

🏝️ Benefits

• 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.

• Telecommute work arrangement available.