Full Time Medical Review - Remote - Family Medicine

Opportunity Criteria

SpecialtyFamily Medicine
Candidate TypeMD, DO
Visa AcceptedNo J1 or H1
Salary RangeNot Specified
Loan RepaymentNot Specified
Employment TypeNot Specified
Bonuses OfferedNone

Remote Full Time Medical Review Opportunity

Medical Review Institute of America (MRIoA) is the market leader for technology-enabled utilization management (UM) and Clinical Review solutions – touching over 35M lives.  For almost 40 years, MRIoA has perfected the utilization and clinical review process for payers of healthcare costs.  We offer the largest, most extensive review network in the industry.  

Our Remote Medical Director opportunity provides our physicians with the advantage of working from the comfort of their own home. Utilizing a desktop computer provided for them, they will be responsible for performing clinical utilization management and peer review activities as well as clinical quality management activities.

Our Medical Directors work full time and are exempt employees, (paid a salary, and not per case) and are held to strict standards of productivity, and quality, including adequate follow-through and thorough, complete responses.

It is important to note, that due to the short turn-around-time frames of the cases completed by our Medical Directors, (typically within a couple of hours), a set work schedule of 40 hours per week is required.

The Schedule will vary, working 5 8-hour days or 4 10-hours a days per week, between the hours of 7am to 7pm MTN TIME ZONE.  This includes a weekend rotation – 1 or 2 weekends a month 7am – 7pm Mtn.

Roles:

  1. Provide an informed, objective voice to the review of coverage decision, and provide recommendations for improving the quality of care, and help shape health plan coverage policy to be consistent with current literature and standard of practice.
  2. Participate in the clinical quality management activities of the corporation.

Major Responsibilities or Assigned Duties:

  1. Perform initial reviews of medical claims.
  2. Perform reviews of appealed claims.
  3. Perform peer-to-peer consultations, with treating/ordering practitioners/providers in accordance with specific client contractual agreements.
  4. Review and adjudicate appeals of pharmacy denials for Pharmacy Benefit Management clients.
  5. Participate in committees as requested.
  6. Supervise the quality of reviews for accuracy; when necessary, perform second review for training purposes and evaluate the reviewing physicians’ logic in their analysis of cases.
  7. Obtain and store research materials useful in reviews.
  8. Keep up to date on coding issues by researching various sources.
  9. Keep up to date on general advances in medicine through continuing medical education.

 

  1. Ensure timely communication with the Chief Medical Director regarding issues or unusual circumstances.
  2. Conduct periodic consultation with practitioners in the field.
  3. Participate in all Company meetings and committees as requested.
  4. Develop clinical guidance insights to assist in reducing health care over-utilization.

Qualifications (Skills, Experience, Educational Requirements):

  • Only applicants interested in FULL TIME work will be considered.
  • MD or DO degree, with a Primary Care specialization (Family Medicine or Internal Medicine only).
  • Less than 1-year lapse in current direct patient care responsibilities.
  • Flexibility – you must be willing and able to be flexible with changes as needed and work additional hours when needed
  • Ability to easily navigate through several computer programs/portals simultaneously.
  • Current, unrestricted medical license as required for clinical practice in any state of the United States.
  • The ability and desire to obtain additional state licenses as required for the position.  
  • Current Board Certification by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) is required.
  • Minimum of five years of full-time equivalent experience providing direct clinical care to patients. 
  • Be credentialed and privileged by the Company's Credentialing Committee.
  • Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards.

 

To apply for this position, please visit:

https://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=13630&clientkey=D5043CDC5E657DE73F03938A8394047E

 

For specific questions, you may contact:

Holly Benson

Medical Recruitment Manager

Medical Review Institute of America, LLC

holly.benson@mrioa.com

 

About MRIoA

Medical Review Institute of America, LLC (MRIoA) was incorporated in 1983. Today MRIoA is an industry leader in providing external review resources for over 800 clients nationwide. MRIoA provides review of medical, dental, behavioral health, pharmacy, vision, disability, workers'? compensation, and auto claims for insurance carriers, employers, TPAs, self- administered union groups, pharmacy benefit managers, human resource consultants and departments of insurance throughout the country. MRIoA utilizes a nationwide network of board-certified physician specialists and professionals in over 133 specialties and sub-specialties of medicine. MRIoA's goal is to render a professional, independent and unbiased opinion to assist our clients with their adjudication challenges or to provide an external source to comply with ERISA/DOL or state laws.

Facility & Address

  • Medical Review Institute of America, LLC - OR
  • OR

Links

Contact Information

Holly Benson Medical Recruitment Manager

Photos

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