EDUCATION/CREDENTIALS:
-Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
-Current, 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 Board);
-Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
-Must be in active medical practice to perform appeals
JOB-RELATED EXPERIENCE:
-Post-graduate experience in direct patient care
- At least 5 years of clinic practice
JOB-RELATED SKILLS/COMPETENCIES:
-Demonstrated computer skills, telephonic skills
-Demonstrated ability to perform review services.
-Ability to work with various professionals including members of regulatory agencies, carriers, employers, 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 current error and omissions liability coverage for job duties and activities performed
-Managed care orientation
-Knowledge of current practice standards in specialty
-Good negotiation and communication skills
WORKING CONDITIONS/PHYSICAL DEMANDS:
-Phone accessability
-Access to a computer to complete reviews
-Ability to complete cases accompanied by a typed report in specified time frames
-Telephonic conferences
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Concentra is an Equal Opportunity Employer M/F/Disability/Veteran
Concentra's Data Protection Commitment
* Concentra is committed to protect patient data and to ensure privacy of personal and medical information.
* Every Concentra colleague has the responsibility to adhere to data protection principles.
* If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.