Are you a talented, Board Certified Neurosurgeon with a passion for fostering work-life balance? We have an exciting opportunity for you to join our Telecommute Medical Review Stream based in Newark, NJ. This flexible contract position allows you to tailor your work schedule and manage your caseload within business hours, Monday through Friday, while earning compensation on a per case basis as a 1099 independent contractor.

In this key role, you’ll leverage your clinical expertise to conduct thorough reviews of health claims, providing crucial medical interpretations and determining the appropriateness of services rendered by fellow healthcare professionals. Your assessments will comply with Concentra Physician Review policies, performance standards, URAAC guidelines, and state regulations.

Key Responsibilities:

• Review medical files and provide informed recommendations for utilization review, assessing medical necessity, appropriateness of care, and return-to-work decisions across various claims including short and long-term disability, Family and Medical Leave Act (FMLA), Group health, and workers’ compensation.
• Collaborate as needed with the Concentra Physician Review Medical Director regarding care quality, credentialing, and licensure matters.
• Ensure you maintain current credentialing, licenses, and any necessary certifications to meet job requirements.
• Deliver timely case reviews with clear, concise rationales and documented criteria.
• Engage professionally with healthcare providers over the phone to discuss case details, required disclaimers, and appeal processes.
• Participate in orientation and training sessions, as well as address any assigned tasks, including quality assurance issues, complaints, regulatory concerns, depositions, court appearances, or audits.
• Utilize current national, state, and professional association guidelines, as well as peer-reviewed literature, to support objective decision-making in reviews and provide requested criteria to providers promptly.

Qualifications:

• Must be a Board Certified MD or DO with a strong grasp of network services, managed care, appropriate service utilization, credentialing, quality assurance, and policy development.
• Hold a current, unrestricted clinical license (or a restricted license with processes in place to comply with state board restrictions).
• Board certification from the American Board of Medical Specialties or the American Board of Osteopathic Specialties is required.
• Active medical practice is necessary for performing appeals.
• Post-graduate experience in direct patient care is essential.

Skills and Competencies:

• Proven telephonic communication and computer skills.
• Capability to effectively perform review services and collaborate with diverse professionals, including regulatory agencies, carriers, employers, nurses, and healthcare providers.
• Maintain a conflict-free approach in medical advisement.
• Present evidence of current errors and omissions liability coverage.
• Strong negotiation and communication abilities.

Working Conditions:

• Access to phone and computer for case reviews and reports.
• Ability to participate in telephonic conferences and manage confidential information securely.

Concentra is proud to be an Equal Opportunity Employer, welcoming individuals from all backgrounds, including veterans and those with disabilities. We are dedicated to upholding data protection, ensuring the privacy of patient and personal information. If you’re ready to contribute to impactful medical reviews in a flexible environment, we encourage you to apply!