Pediatrician

3 weeks ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Direct message the job poster from Maximus

We are looking for a 100% Remote, 1099, Pediatric Infectious Disease 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.

S ystems 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

P rovider Specialty

Pediatric Infectious Disease

M inimum Qualifications:

•24 hours of direct patient care per week

•5 years’ experience in appropriate specialty post training

M edical Necessity Review: Standard Case

Most common type of review

30 – 45 minutes to complete

5 – 7 days to turnaround

M edical Necessity Review: Expedited Case

Sickest patients 24-hour turnaround

45 min - 1 hour to complete

E xperimental/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

E xperimental/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.

Keith Stewart

Clinical Recruiter

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider and Consulting

• Industries

  Hospitals and Health Care and Government Administration

Referrals increase your chances of interviewing at Maximus by 2x

Sign in to set job alerts for “Pediatrician” roles.

Pediatrics - Infectious Disease Physician Job with UPMC in Pittsburgh, PA

Pediatrician Advisor at Healthcare Venture Capital Fund - Healthcare Shares

Fresno, CA $320,000.00-$380,000.00 3 months ago

Neonatologist Advisor at Healthcare Venture Capital Fund - Healthcare Shares

Child & Adolescent Psychiatry Utilization Review - (Remote - 1099) TX

Lamont, CA $265,000.00-$290,000.00 1 month ago

Naturopathic Doctor (Part-Time/Contract) - Future Openings

Medical Affair- ophthalmology required （contractor）

California, United States $120.00-$130.00 6 days ago

Greenville, SC $300,000.00-$400,000.00 2 days ago

Hospitalist Advisor to Healthcare Venture Capital Firm

Ophthalmology - Remote 1099 Utilization Review Work

Locum Tenens Physician - Make $380/hr - $400/hr

Columbia, SC $300,000.00-$400,000.00 2 days ago

Greenville, SC $300,000.00-$400,000.00 1 day ago

Florence, SC $300,000.00-$400,000.00 1 day ago

Oregon, United States $155.00-$165.00 3 months ago

Physician - Virtual Urgent Care (Part-time)

Clinical Research Physician - Development

Indiana, United States $198,000.00-$336,600.00 1 day ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.