Spine Surgeon – Telecommute Medical Review

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

📋 Description

• Evaluate health claims and medical documentation.

• Deliver medical interpretations and make decisions regarding the suitability of services.

• Conduct utilization reviews, chart assessments, and evaluations of medical necessity and care appropriateness.

• Assess return-to-work, 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 as necessary.

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

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

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

• Articulate disclaimers and appeal procedures to providers.

• Participate in orientation and training sessions.

• Identify and address matters related to quality assurance, complaints, regulatory issues, depositions, court appearances, and audits.

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

• Provide timely copies of requested review criteria to providers.

⛳️ Requirements

• Board certified MD or DO specializing in orthopedic or neurosurgery.

• Possession of a current, unrestricted clinical license; candidates must hold a California license.

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

• Must be actively practicing medicine to handle appeals.

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

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

• Proven computer and telephonic proficiency.

• Demonstrated capability to carry out review services.

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

• No financial conflicts of interest are permitted.

• Current errors and omissions liability coverage for job-related duties and activities.

• Orientation towards managed care.

• Familiarity with current practice standards in the specialty area.

• Strong negotiation and communication skills.

• Access to a phone.

• Computer access for review completion.

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

• Ability to engage in telephonic conferences.

• Competence in managing confidential and sensitive information securely.

🏝️ Benefits

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

• Compensation per case as a 1099 independent contractor.

• Option for telecommuting work arrangement.