Telecommute Spine Medical Review Physician

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

📋 Description

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

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

• Ensure the maintenance of appropriate credentialing, state licenses, special certifications, and other necessary qualifications.

• Return cases in a timely manner with clear, concise, comprehensive rationales and documented criteria.

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

• Explain disclaimers and appeal procedures to providers.

• Participate in orientation and training sessions.

• Identify and address quality assurance, complaint, regulatory, deposition, court appearance, and audit issues.

• Evaluate, critique, and apply current criteria, national and state guidelines, professional association standards, and peer-reviewed literature.

• Provide requested review criteria to providers promptly.

• Safeguard confidential and sensitive patient information.

⛳️ Requirements

• Board-certified MD or DO.

• Valid, unrestricted Texas clinical license (or a restricted license approved through the organization's process).

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

• Must be actively practicing medicine to handle appeals.

• Post-graduate experience in direct patient care.

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

• Proven computer and telephone communication skills.

• Demonstrated ability to conduct review services effectively.

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

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

• Orientation towards managed care.

• Knowledge of contemporary practice standards within the specialty.

• Strong negotiation and communication abilities.

• Access to a phone.

• Access to a computer for completing reviews.

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

• Ability to engage in telephonic conferences.

🏝️ Benefits

• Flexible scheduling and customizable caseload within a Monday–Friday workweek during business hours.

• Compensation is based on a per-case basis.

• Independent contractor arrangement (1099).