United States Job Openings
Confidential
Physician Peer Reviewer (Medical Necessity Review for Worker's Compensation Claims)
CONTRACT
October 17, 2024
Physician Reviewer will act as an Independent Contractor to our organization when providing services.
Rate: $75 to $95 per review
Requirements:
1. Maintains unrestricted license (M.D. or D.O)
2. Actively practices within their scope of practice and maintains knowledge of specialty
3. Board certified in specialty (if applicable)
4. Located in a State or Territory of the United States when conducting a Peer Review
5. Access to MTUS/other evidence-based guidelines and understanding of how to apply guidelines
6. Understanding of Utilization Management as it pertains to California Worker's Compensation System in California
Duties
- Receive requests for authorization (RFA's) sent by our organization to consultant and confirm receipt of RFA's and supporting medical documentation within the same business day.
- Review all of the documentation previously considered by non-physician reviewer and determine if the proposed treatment in the RFA should be certified, non-certified, or modified based off medical necessity of the treatment given the facts of the case.
- Use his/her medical expertise and will consult the Medical Treatment Utilization Schedule (MTUS) adopted by the Administrative Director pursuant to Labor Code section 5307.27, in addition to other nationally recognized, evidence-based guidelines developed on sound clinical processes and principles by physicians in active clinical practice, peer-reviewed and updated annually such as ACOEM Guidelines, the Work Loss Data Institute's Official Disability Guidelines (ODG), and other national scientific peer reviewed publications, Evidence from medical records/case documentation.
- Provide further clarification of information of a completed review as requested and respond promptly to our organization's inquiries by email and/or phone
- Strong communication skills to effectively interact with all team members.
- Ability to work collaboratively within a multidisciplinary team environment.
- Excellent problem-solving skills and the ability to make informed decisions under pressure.
Schedule:
- Choose your own hours
- BC/BE (Required)
- Medical License (Required)
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