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As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims.The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare profe

Job Description Overview Are you an accomplished Board Certified Spine Surgeon or 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.

Ensure adherence to all clinical guidelines, safety protocols, and regulatory requirements. Excellent diagnostic, clinical, and procedural skills. Clinical Procedures & Interventions:.

Participate in clinical meetings, staff meetings, required training, and supervision. This position provides clinical services as part of an Article 31 OMH certified outpatient MHOTRS clinic. Clinical services are provided using a trauma-informed, evidence-based, racially & culturally affirming appr

Maintain accurate, timely, and thorough documentation in accordance with clinical, legal, and regulatory standards. Strong clinical knowledge of medical-surgical nursing practices and patient care standards. This position offers an excellent opportunity for professional growth in a dynamic clinical

This position provides clinical services as part of an Article 31 OMH certified outpatient MHOTRS clinic. Clinical services are provided using a trauma-informed, evidence-based, racially & culturally affirming approach. Be actively self-reflective & self-aware of how clinical and administrative prac

The Social Worker is responsible for supplying necessary clinical intervention within the realm of the program.

At SCT, we handle all the administrative responsibilities -- including billing, insurance, credentialing, and pre certifications --- so you can do what you do best: providing exceptional clinical care!. Maintain accurate and timely clinical documentation in accordance with regulatory standards using

The Social Worker is responsible for supplying necessary clinical intervention within the realm of the program.

Previous clinical experience in a subacute, long-term care, or geriatric healthcare setting. Licensed Clinical Social Worker LCSW -. Are you passionate about working with an underserved and rewarding population? Looking for a clinical role without the administrative burden, and one that offers real

We're currently looking for individuals across the country to take part in remote paid research, including remote focus groups, product trials, and consumer studies.Earn up to $750 a week in your free time by providing feedback on everyday products and services.If you're comfortable sharing your opi

Instead of juggling multiple patients, alarms, and constant interruptions, you provide dedicated, one-on-one care in the home, allowing you to focus fully on your patient and use your clinical judgment with confidence. Nurses who thrive here value autonomy, continuity of care, and the ability to del

Instead of juggling multiple patients, alarms, and constant interruptions, you provide dedicated, one-on-one care in the home, allowing you to focus fully on your patient and use your clinical judgment with confidence. Nurses who thrive here value autonomy, continuity of care, and the ability to del

We are seeking a professional, dependable, and motivated Administrative Assistant / Receptionist to support day-to-day office operations.This individual will serve as the face of the organization, handling incoming calls, greeting clients and visitors, and supporting internal teams.Based on performa

Our practice is looking for a nurse practitioner or physician assistant with focus on a geriatric population.Opportunity to work a hybrid role with a combination of nursing home and outpatient in an office setting.Candidate must provide the full scope of primary care services with extensive past exp

We are excited to announce that our new Urgent Care Center is looking for an experienced, board-certified Family Medicine Nurse Practitioner to join our team.If you have a passion for providing quality care and making a difference in the lives of patients, we want to hear from you!.See patients of a

Job Description & Requirements Neonatology Nurse Practitioner or Physician Assistant(NP) StartDate: ASAP Pay Rate: $97.This facility is seeking a Neonatology Nurse Practitioner or Physician Assistant(NP) for locum tenens support as they look to fill a current need.

Are you a compassionate Pediatrician looking for a rewarding opportunity? We have the perfect position for you!.Seeing 25-30 patients per 8-hour day.State license, bilingual (Medical Spanish), and BLS required.Malpractice Insurance For more jobs like this, check out.

Data Entry / Remote] - Anywhere in U.Competitive pay - As a Data Verification Analyst at Foundation AI, you will: Process, segregate, review, and validate data provided in various formats according to changing process requirements; Prepare, compile, and organize documents for data capture, ensuring

Atlantic Health is Seeking a Part-Time Nurse Practitioner for Assisted Living and Home Visits.Atlantic Health, one of New Jersey's largest non-profit healthcare networks, is currently seeking a dedicated Nurse Practitioner (NP) to join the Assisted Living and Home Visit Team located near Union, New

Locum Tenens Psychiatric Nurse Practitioner Needed Now! Need is for one day per month, as a consulting Psychiatric Nurse Practitioner.Flexible Schedule!!! All adult, all outpatient.If you are interested and would like more information, please contact Andrew McKinney at 800-783-9152 ext.NJ541Lb - Psy

Only QUALIFIED Healthcare Professionals accepted).Family-NP - We are currently seeking a Pediatric Nurse Practitioner FNP or Physician assistant to join our team.Must be bilingual English and Spanish to treat Spanish speaking patients.Conduct health maintenance care, including well-child exams and c

Exceptional clinical insights coupled with an empathetic approach. Collaborative, mission-driven clinical environment.

Seeking a psychiatric nurse practitioner immediately for an all outpatient facility! This is a part time position in northern New Jersey just 30 minutes from New York City's Manhattan borough.Enjoy a great salary while developing personal relationships with young children and a like-minded staff who

Join Our Team at Progressive Pediatrics as a Pediatric Nurse Practitioner.North Jersey (In-Office Locations).We are seeking a Pediatric Nurse Practitioner to join our team at Progressive Pediatrics in North Jersey.Our physician owned medical practice has been providing exceptional care for 25 years,

Provides training to clinical staff on new policies, protocols, and procedure as appropriate. Must be able to make quick and accurate clinical assessments and have knowledge of medical practices, terminology, and computer software skills.

You will be a part of a team with ongoing support from operations, technology, and clinical colleagues. The NP/PA for Medcor will provide excellent primary clinical care in an occupational and urgent care health clinic. This position will work closely with a Medcor employed oversight physician assig

The NP provides primary health care through assessment, diagnosis, clinical judgment and management to restore, maintain and improve the health status of patients.

A passion for patient care and clinical expertise are essential.

One (1) year experience in family medicine and/or clinical setting is required.

NEW! A PMHNP is needed to see women and children in an inpatient setting near Newark.Psychiatric Mental Health NP ANCC-BC preferred with experience in women's health and child population.Exciting opportunity for a confident and flexible prescriber seeking a rewarding new position.If you are interest