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Job Title: Surgical Clinical Reviewer Location: Cooperman Barnabas Medical Ctr Department Name: Department of Surgery Req #: 0000238249 Status: Salaried Shift: Day Pay Range: $58,000.00 - $78,000.00 per year Pay Transparency: The above reflects the anticipated annual salary range for this position if hired to work in New Jersey. The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience. Job Overview: The Surgical Clinical Reviewer s chief responsibility is to collect and submit reliable data to the ACS NSQIP, This is accomplished through high-quality data compilation, documentation and entry into the ACS NSQIP database of all eligible surgeries for the hospital.The SCR works closely with the members of the Department of Surgery to identify opportunities for clinical quality improvement (QI), patient safety (PS) initiatives, and other special projects as may be identified. The SCR will also be responsible for assisting surgical residents in identifying and initializing QI and PS research projects, Qualifications: Required * Master's level degree in a health care related field. * Ability to complete all training modules and pass the ACS NSQIP certification examination, Preferred: * Minimum one year experience in hospital surgery department, surgery clinic, clinical research or medical records, * Contact with Others: Administrators, physicians, residents, students, hospital personnel, patients/patient families * Computer and Internet experience required — familiarity and comfort with MS Office products is essential for success in this position (Word and Excel- required; PowerPoint and Access preferred). Scheduling requirements: * Full time days * Fully remote in New Jersey. Essential Functions: * Identifies surgical patients for inclusion in the Program through the application of Program inclusion/exclusion criteria and protocols. * Collects preoperative, operative, and postoperative data components for the Program through the effective utilization of the hospital medical record systems. * Attends weekly Quality Improvement (Morbidity & Mortality, Tumor Board, etc.) conferences to ensure reliable data collection of postoperative occurrences. * Demonstrates applicability of the methodology and the reliability of definitions utilized by reviewers within the Program through Inter-Rater Reliability (IRR) testing * Identifies streamlining and process improvement opportunities in the data collection process. * Demonstrates appropriate utilization of resources necessary to obtain valid, reliable data for entry into the Program * Establishes effective working relationships with members of the hospital community, especially staff in the Surgery, Medicine, Nursing, Health Information Management and the Information Systems Departments whose support is necessary for the management and success of the Program. * Contacts patients and/or families via telephone and/or written communications postoperatively for the purpose of identifying possible occurrences associated with surgical procedures performed at the hospital. * Serves as an educational resource on the ACS NSQIP for internal and external audiences by developing educational material and delivering presentations. * Successfully completes the ACS NSQIP SCR Training/Certification Program. * Participates in Program teleconferences. Attends ACS NSQIP National Conference. Benefits and Perks: At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to supports our employees’ physical, emotional, social, and financial health. * Paid Time Off (PTO) * Medical and Prescription Drug Insurance * Dental and Vision Insurance * Retirement Plans * Short & Long Term Disability * Life & Accidental Death Insurance * Tuition Reimbursement * Health Care/Dependent Care Flexible Spending Accounts * Wellness Programs * Voluntary Benefits (e.g., Pet Insurance) * Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more! Choosing RWJBarnabas Health! RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey—whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education. Equal Opportunity Employer

Job Description Overview Are you an accomplished Board Certified Neurosurgeon? Are you passionate about your work/life balance? We are seeking flexible and experienced physicians for our medical reviewstream division. This telecommute role provides the ability for you to customize your schedule and caseload within a Monday - Friday work week and within business hours. Create a flexible work schedule and be compensated on a per case basis as a 1099 independent contractor. Candidates must have a NJ license. JOB SUMMARY: 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. Responsibilities MAJOR DUTIES AND RESPONSIBILITIES: • 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., • Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues., • Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job., • Returns cases in a timely manner with clear concise and complete rationales and documented criteria., • Telephonically contacts providers and interacts with other health professionals in a professional manner. Discusses the appropriate disclaimers and appeal process with the providers., • Attends orientation and training, • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits., • 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., • Provides copies of any criteria utilized in a review to a requesting provider in a timely manner Qualifications EDUCATION/CREDENTIALS: -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 is required for MD or DO reviewer. -Must be in active medical practice to perform appeals JOB-RELATED EXPERIENCE: Post-graduate experience in direct patient care JOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills -Demonstrated ability to perform review services. -Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Medical direction shall also be provided consistent with the requirement that the physician advisor shall not have a financial conflict of interest -Must present evidence of current error and omissions liability coverage for job duties and activities performed -Managed care orientation -Knowledge of current practice standards in specialty -Good negotiation and communication skills WORKING CONDITIONS/PHYSICAL DEMANDS: -Phone accessability -Access to a computer to complete reviews -Ability to complete cases accompanied by a typed report in specified time frames -Telephonic conferences This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management. Concentra is an Equal Opportunity Employer M/F/Disability/Veteran Concentra's Data Protection Commitment • Concentra is committed to protect patient data and to ensure privacy of personal and medical information., • Every Concentra colleague has the responsibility to adhere to data protection principles., • If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

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As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

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