Are you a Board Certified Family Practice physician seeking an exciting opportunity that allows you to enjoy a fulfilling work/life balance? If you hold a valid NJ medical license and have a passion for flexible work arrangements, we invite you to join our dynamic medical reviewstream division in a telecommute role.

In this independent contractor position, you’ll have the freedom to create a customized schedule and manage your caseload within standard business hours, Monday through Friday. Your compensation will be based on a per case structure, allowing you to optimize your workload according to your personal and professional needs.

As a vital member of our team, you will leverage your clinical expertise to review healthcare claims, providing medical interpretations and decisions regarding the appropriateness of services rendered by other healthcare professionals. Your work will be guided by Concentra’s Physician Review policies, procedures, performance standards, and applicable URAAC guidelines, all while adhering to state regulations.

Key Responsibilities:

• Conduct thorough reviews of medical files to assess medical necessity, appropriateness of care, and recommendations for return to work and disability claims (both short- and long-term).
• Collaborate with our Medical Director when necessary to discuss quality of care and credentialing issues.
• Ensure your credentials and state licenses remain current, along with any specialized certifications pertinent to your role.
• Timely completion of cases with clear and comprehensive rationales and documented criteria.
• Engage in professional communication with healthcare professionals and providers via phone consultations.
• Explain the appeal process and necessary disclaimers to providers.
• Participate in orientation and training sessions, and address any quality assurance or compliance issues that arise.

Qualifications:

Education & Credentials:

• MD or DO, board certified, with a deep understanding of managed care, appropriate utilization of services, and quality assurance.
• Hold a current, unrestricted clinical license, or have mechanisms in place to ensure compliance even if licenses are restricted.
• Board certification from the American Board of Medical Specialties or the American Board of Osteopathic Specialties is essential.
• Active participation in medical practice is required for performing appeals.

Experience & Skills:

• Extensive post-graduate experience in direct patient care.
• Proven proficiency with computer systems and telephonic communication.
• Strong capability to provide review services across various stakeholders, including regulatory agencies and healthcare professionals.
• Adherence to ethical medical direction principles without financial conflicts of interest.
• Current error and omissions liability coverage is mandatory.

Physical Requirements:

• Phone connectivity and access to a computer for completing reviews.
• Ability to finish cases accompanied by written reports within designated timeframes.
• Participation in telephonic conferences as required.

This role involves handling confidential information, making discretion and secure information management imperative.

As part of our commitment to diversity, Concentra is proud to be an Equal Opportunity Employer. We welcome applications from individuals regardless of race, color, religion, gender, sexual orientation, disability, age, or veteran status. Join us in our mission to protect patient data and ensure the confidentiality of medical information with each interaction.