Physiatry Practice Management Resources

Job Description

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 California.

Job Requirements
BC or BE in Physical Medical and Rehabilitation (preferred) or will look at FP and Occupational Medicine.