Orthopedic Surgeon Telecommute Medical Review Stream Physician

Overview Are you an accomplished Board Certified Orthopedic Surgeon physician ? Do you want a flexible work/life balance? We are seeking experienced physicians for our medical reviewstream division. This telecommute role allows you to customize your schedule and caseload within a Monday‑Friday work week and business hours. Compensation is per case as a 1099 independent contractor. Candidates must have a CA license. JOB SUMMARY: Relying on clinical background, the reviewer evaluates health claims, provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, performance standards, URAAC guidelines and state regulations. Responsibilities Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return-to-work decisions for short and long-term disability, FMLA, group health and workers’ compensation claims. Meet (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues. Maintain proper credentialing, state licenses and any special certifications or requirements necessary for the role. Return cases in a timely manner with clear, concise, and complete rationales and documented criteria. Contact providers telephonically and interact professionally with other health professionals; discuss appropriate DISCLAIMERS and appeal process with providers. Attend orientation and training and perform other duties as assigned, including addressing quality assurance issues, complaints, regulatory issues, depositions, court appearances or audits. Critique and utilize current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision making and rationales in reviews. Provide copies of any criteria used in a review to a requesting provider in a timely manner. Qualifications Board certified MD or DO, with a strong understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance, and policy development. Current, unrestricted clinical license(s) in California (or a process to ensure job functions do not violate state board restrictions). Board certification by the American Board of Medical Specialties or American Board of Osteopathic Specialties is required. Active medical practice to perform appeals. Post‑graduate experience in direct patient care. Demonstrated computer and telephonic skills; ability to perform review services. Ability to collaborate with regulatory agencies, carriers, employers, nurses and other health professionals. Medical direction shall be consistent with the requirement that the physician advisor has no financial conflict of interest. Evidence of current error and omissions liability coverage for duties performed. Managed care orientation and knowledge of current practice standards in the specialty. Good negotiation and communication skills. Working Conditions & Physical Demands Telephonic and computer access required. Must complete cases with typed reports within specified time frames. Access to confidential and sensitive information with ongoing discretion and secure information management. Compensation This position is eligible to earn a base compensation rate in the state range of $30.00 to $90.00 hourly, depending on job‑related factors such as level of experience, geographic location, and seniority. Equal Opportunity Employer Concentra is an Equal Opportunity Employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local laws, including the Los Angeles Fair Chance Ordinance. We prohibit discrimination on the basis of race, color, national origin, religious beliefs, sex (including pregnancy), age, disability, sexual orientation, gender identity, citizenship status, military status, marital status, genetic information, or any other basis protected by federal, state or local fair employment practice laws. Data Protection Commitment Concentra is committed to protecting patient data and ensuring privacy of personal and medical information. Every colleague has the responsibility to adhere to data protection principles. If a role includes handling or processing sensitive data, role‑specific policies and requirements apply to ensure protection of patient information. #J-18808-Ljbffr Concentra