Staff Physician Reviewer
Posted on November 29, 2008
Filed Under MediCall Philippines, Medical / Health / Safety, NCR |
MediCall Philippines, Inc.
MediCall is a leading provider of specialized Healthcare Communications services. Incorporating experienced healthcare professionals, state-of-the-art information technology infrastructure and a world-class operations team, MediCall has created a unique value proposition for our healthcare clients.
MediCall utilizes highly qualified Philippine nurses, pharmacists, physicians and other healthcare specialty providers to manage all calls. This allows our staff to specialize in the handling of Medical Management, Benefits Management, Customer/Member/Provider Services and Sales/Marketing/Enrollment calls. MediCall offers scalable solutions for ongoing and short-term communications management, using dedicated teams of healthcare professionals for clinical and non-clinical calls. Our team is professional, highly credible and effective.
Staff Physician Reviewer
I. Job Summary:
Utilization Review Medical Necessary Evaluations
This program provides physician-based review services, which are defined in the industry as “the evaluation of medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities.”
Peer Review / Chart Reviews
The Peer Review / Chart Review product is a medical chart review to address any of the following issues: a review of medical necessity of a requested health care service, either proposed or given, as well as compensability, relatedness, Maximal Medical Improvement, impairment ratings, etc.
II. Essential Duties And Responsibilities:
• Reviews treatment requests on workers’ compensation claims to determine medical necessity and appropriateness of care
• Compares treatment requests to evidence based clinical guidelines
• Prepares documentation in a template format
• Adheres to company turnaround time requirements for completion of reviews
• Performs chart reviews to address multiple issues as assigned
• Maintains acceptable levels of performance including but not limited to attendance, adherence, customer courtesy, and all other productivity and efficiency targets and objectives
• Learns new methods and services as the job requires
• Other related duties assigned
III. Relationships:
• Interpersonal Communication – arriving at common understanding with others, showing effective listening and feed backing behavior. Can communicate effectively and work well with people in all levels within the organization.
• Relationship Building Skill – establishing relationships and networks across a broad range of people and groups
• Teamwork and Cooperation – works well with others towards achieving desired results, clarifies goals and roles and initiates clarification and conflict resolution.
• Customer Service Orientation – desire to help or serve others
IV. Job Qualifications And Requirements:
Education:
The Physician Review program candidate must have an unrestricted board certified PRC license to practice as a physician and have any special certificates such as Board certification in a specialty relevant to the types of reviews performed.
Credentials:
• Board certified MD 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)
• Specialty in orthopedic surgery, physical medicine & rehabilitation or occupational medicine preferred.
Qualifications:
Job Relevant Experience:
Post-graduate experience in direct patient care and the experience with the different type of physician reviews performed:
• Utilization Review/Medical Necessary Review
• Peer Reviews
• Worker’s Compensation
• General Liability
• Group Health
Job-Related Skills / Competencies:
• Demonstrated advanced computer and communication skills
• Ability to read and summarize clinical records efficiently
• Ability to work in an office-based environment
• Expertise in clinical problem-solving
• Demonstrated ability to perform review services
• Ability to work with various professionals including nurses and health care professionals
• Medical direction shall also be provided consistent with the requirement that the physician reviewer shall not have a financial conflict of interest
• Evidence-based practice guidelines orientation
• Knowledge of current practice standards in specialty
Work Schedule:
• Able to work rotational shifts with adherence to schedule a must, including evenings, weekends and overtime as necessary
• Willingness to render extended hour/s as the need arises
Interested applicants may submit their resume at:
Email: bbaylon@medicall.ph
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