Job Summary
A national healthcare company is searching for a person to fill their position for a Telecommuting Board Certified General Surgeon Utilization Review Physician in Dallas.
Individual must be able to fulfill the following responsibilities:
- Review medical files and provide 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, Group health and workers’ compensation claims
- Meet (when required) with Physician Review Medical Director to discuss the quality of care and credentialing and state licensure issues
- Telephonically contact providers and interacts with other health professionals in a professional manner
Must meet the following requirements for consideration:
- Board certified MD, DO, in Texas 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)
- Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer
- Active medical practice to perform appeals
- Post-graduate experience in direct patient care
- Present evidence of current error and omissions liability coverage for job duties and activities performed
