Physiatry Practice Management Resources

Job Description
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.

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, Federal Management Leave Act, Group health and workers' compensation claims.
' Assists the Concentra Physician Review Medical Director with recruiting, credentialing, training and educating physician and non-physician reviewers, CPR staff and customers and with quality assurance.
' Meets regularly 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 provider in a timely manner
' Performs and participates in Quality Assurance activities such as monthly review of physician charts for quality checks, tracking and trending of results and on-going quality improvement and training of reviewers.
' Prepares and delivers educational seminars and teleconferences to CPR physician and non-physician advisors, including orientation programs and newsletters.
' Educates, teaches and trains nurses, adjusters, and CPR staff including developing teaching conferences for CPR customers and carriers and TCM/UR staff and participation in Grand Rounds
' Recruits and credentials new reviewers.
' Attends regular CPR staff physician meetings with CPR Medical Director.Develops and assists with the maintenance of policies and procedures to assure best practices.
' Develops teaching and training manuals to educate reviewers.
' Identifies, reviews and critiques current criteria, national and professional association guidelines and peer-reviewed literature.
' Assists Account representatives and sales teams in obtaining new business and maintenance of current customers.
* Must be licensed in Texas.

Job Requirements
BC in Physicial Medicine and Rehabilitation.Some experience doing Physician Review Audits and qualify assurance.

Must also work clinically and have an active Texas license.
This position will work out of our Addison/Carrollton Center.