Hematologist

We are looking for a 100% Remote, 1099, Hematology Oncology MD/DO Reviewer

Description

• Medical Expert Reviewer-Medical Expert Judgement Reviews determining final decision based off enrollee’s denial of treatment coverage denied by the CA DMHC.
• Reviews are based off Medical Necessity and Experimental/Investigational.
• Specialty Driven-Expert within the Specialty Requested.

This service involves getting a thorough and professional medical review from an expert provider. The review is done to make a final decision on whether a particular treatment should be covered by the CA DMHC (Department of Managed Health Care) or not. The reviews are based on two main factors: medical necessity (whether the treatment is necessary for the patient's health) and whether the treatment is experimental or investigational.

Systems and Tools

• Expert Reviewers must use their own personal computer to access a web-based portal.
• Review Training –Trainer will work closely with reviewer for the first 3-5 cases.
• Scheduled Training- based on reviewer’s schedule.
• No direct defined evidence standard or guidelines.
• Templates will be used to complete reviews.

Provider Specialty

Minimum Qualifications

• 24 hours of direct patient care per week.
• 5 years’ experience in appropriate specialty post training.

Medical Necessity Review: Standard Case

Most common type of review.

30 – 45 minutes to complete.

5 – 7 days to turnaround.

Medical Necessity Review: Expedited Case

Sickest patients 24-hour turnaround.

45 min - 1 hour to complete.

Experimental/Investigational Reviews: Standard Case

Second most common review.

1-2 hours to complete (based on experience).

5 - 7-day turnaround.

Volume: Varies based on need.

Experimental/Investigational Reviews: Expedited Case

Sickest of patients 24-hour turnaround.

1-2 hours to complete (based on experience).

For more information about Maximus, please visit to learn more about our organization.