Medical Consultants Network is a URAC accredited organization that manages medical peer reviews and IMEs nationwide. We are seeking clinically experienced physicians to join our IRO panel & assess healthcare appeals for medical necessity and make objective recommendations as to whether or not treatment is required.
Responsibilities
- Utilization Review. You will be asked to evaluate appeals where a patient has been denied treatment by their health plan. You will use evidence-based medicine to make a recommendation to either overturn or uphold the denial based on one or more of the following: Medical Necessity, Experimental Treatment, and/or Policy Language.
- Citation of References. You will be required to provide 3-5 scholarly references to back up your opinion. These can include scientific studies, medical journals, standard of care guidelines, and/or other medically relevant sources. You will not be required to spend long amounts of time researching sources, and will be provided a list of potential options with links when you start out on the panel.
- Contact treating providers. You may occasionally be required to attempt contact with the patient’s treating provider(s) to seek any additional information that could affect the outcome of the case.
Qualifications
- Board Certified and 5+ years clinical experience in Gastroenterology
- Must hold current and valid medical license in the United States
- You must maintain at least part-time clinical practice
- Past experience with utilization review is preferred but not required
Job Types: Part-time, Contract
Pay: From $100.00 per hour
Benefits:
Schedule:
Application Question(s):
- Are you board certified through the American Board of Internal Medicine?
Work Location: Remote