Job Summary

A national healthcare company is in need of a Telecommute Orthopedic Hand Surgeon Physician Medical Reviewer in Houston.

Individual must be able to fulfill the following responsibilities:

• Review 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 Act (FMLA), Group health and workers’ compensation claims
• Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues
• Return cases in a timely manner with clear concise and complete rationales and documented criteria

Required Skills:

• 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 for MD or DO reviewer
• Active medical practice to perform appeals
• Post-graduate experience in direct patient care
• Ability to present evidence of current error and omissions liability coverage for job duties and activities performed