Spine Surgeon – Telecommute Medical Review

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

📋 Description

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

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

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

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

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

• Clarify applicable disclaimers and appeal procedures to providers.

• Participate in orientation and training sessions.

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

• Analyze, critique, and apply current national, state, and professional guidelines and peer-reviewed literature to substantiate objective review decisions.

• Provide requested copies of review criteria to providers in a timely fashion.

⛳️ Requirements

• Board certified MD, DO, Spine Surgeon, or Neurosurgeon.

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

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

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

• Post-graduate experience in direct patient care.

• Familiarity with network services, managed care, service utilization, credentialing, quality assurance, and policy formulation.

• Proven computer and telephonic capabilities.

• Demonstrated proficiency in executing review services.

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

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

• Managed care orientation is essential.

• Awareness of contemporary practice standards in the specialty.

• Strong negotiation and communication skills.

• Access to a phone and computer to complete reviews.

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

• Willingness to engage in telephonic conferences.

• Ongoing discretion and secure management of information when dealing with confidential and sensitive data.

🏝️ Benefits

• Flexible schedule and caseload within a Monday–Friday workweek and business hours.

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

• Telecommute work arrangement.

• Independent contractor position.

• Orientation and training provided.