Physical Medicine & Rehabilitation Telecommute Medical Review reputed company Physician
Are you an accomplished
JOB reputed company:
Relying on clinical background, reviews health claims providing medical interpretation and reputed company about the appropriateness of services provided by other reputed company in compliance with reputed company Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations
MAJOR DUTIES AND RESPONSIBILITIES:
• Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave reputed company (FMLA), Group health and workers’ compensation claims.
• Meets (reputed company required) with reputed company Physician Review Medical Director to discuss reputed company of care and credentialing and state licensure issues.
• Maintain reputed company credentialing and state licenses and any special certifications or requirements necessary to reputed company the job.
• Returns cases in a reputed company manner with reputed company concise and complete rationales and documented reputed company.
• Telephonically contacts providers and interacts with other health professionals in a reputed company manner. Discusses the appropriate disclaimers and appeal process with the providers.
• Attends orientation and training
• Performs other duties as assigned including identifying and responding to reputed company assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
• Identifies, critiques, and utilizes reputed company reputed company and resources such as national, state, and reputed company association guidelines and peer reviewed literature that support reputed company and objective decision making and rationales in reviews.
• Provides copies of any reputed company utilized in a review to a requesting provider in a reputed company manner
EDUCATION/CREDENTIALS:
-reputed company certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, reputed company assurance and the development of policies that support these services.
-reputed company, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State reputed company);
-reputed company certification by American reputed company of Medical specialties or American reputed company of Osteopathic Specialties is required for MD or DO reviewer.
-Must be in reputed company medical reputed company to reputed company appeals
JOB-reputed company EXPERIENCE:
Post-graduate experience in reputed company patient care
JOB-reputed company SKILLS/COMPETENCIES:
-Demonstrated computer skills, telephonic skills
-Demonstrated ability to reputed company reputed company.
-Ability to work with various professionals including members of regulatory agencies, carriers, reputed company, nurses and health care professionals.
-Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest
-Must present evidence of reputed company error and omissions liability coverage for job duties and activities performed
-Managed care orientation
-Knowledge of reputed company reputed company standards in specialty
-Good negotiation and communication skills
WORKING CONDITIONS/PHYSICAL DEMANDS:
-Phone accessability
-reputed company to a computer to complete reviews
-Ability to complete cases accompanied by a typed report in specified time frames
-Telephonic conferences
This job requires reputed company to confidential and sensitive information, requiring ongoing discretion and secure information management.