Internal Medicine Jobs in Texas
Thursday · July 19, 2018
1 Job in The Lone Star State
Photo: Approaching downtown Dallas on the expressway.
The annual salary for this job depends on experience.
This permanent internal medicine job (Addison) is from a hospital-owned practice.
- This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
- Access to a computer to complete reviews.
- Must be in active medical practice to perform appeals.
- Discusses the appropriate disclaimers and appeal process with the providers.
- Identifies, critiques, and utilizes 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.
- Telephonically contacts providers and interacts with other health professionals in a professional manner.
- Major Duties AND.
- Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and Uraac guidelines and state regulations.
- Provides copies of any criteria utilized in a review to a requesting provider in a timely manner.
- Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
- Medical Review Stream by Concentra is currently looking for a board certified PRN Phyisician for peer review.
- Knowledge of current practice standards in specialty.
- Phone accessability.
- Returns cases in a timely manner with clear concise and complete rationales and documented criteria.
- Attends orientation and training.
- 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).
- Physician - Internal Medicine Job in Addison, TX.
- Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals.
- Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues.
- Reviews 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.
- Good negotiation and communication skills.
- Concentra's Data Protection Commitment.
- Post-graduate experience in direct patient care.
- Demonstrated ability to perform review services.
- Demonstrated computer skills, telephonic skills.
- Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
- Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
- Must present evidence of current error and omissions liability coverage for job duties and activities performed.
- Telephonic conferences.
- Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest.
- 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.
- Ability to complete cases accompanied by a typed report in specified time frames.
- Every Concentra colleague has the responsibility to adhere to data protection principles.
- Managed care orientation.
This perm job opening was posted
2 weeks ago