Job Description

About the Company

100% fully remote, 1099, supplemental income, remote Internal Medicine, MD/DO role.

California Dept of Managed Health Care Independent Medical Review CA DMHC-IMR Project.

Must have Hematology/ Oncology experience as well.

About the Role

These reviews will be strictly related to Internal Medicine specialty.

Responsibilities

• Medical Expert Reviewer-Medical Expert Judgement Reviews determining final decision based off enrollee’s denial of treatment-coverage denied by the DMHC.
• Reviews are based off Medical Necessity and Experimental/Investigational.
• Specialty Driven-Expert within the Specialty Requested.
• This service involves getting a thorough and professional medical review from an expert provider.
• The review is done to make a final decision on whether a particular treatment should be covered by the DMHC (Department of Managed Health Care) or not.
• The reviewers who conduct these medical judgment reviews are experts in the specific field of medicine related to the treatment being considered.
• Provider can accept or decline cases; must do so within 24 hrs.
• Once accepted the review must be submitted within 3-5 business days, expedited cases are within 24 hours.

Qualifications

• Active license **Any state license can be used for this role**
• 24 hours of direct patient care per week currently
• 5 years’ experience post fellowship
• Board Certification
• Decline any reviews without penalty (24 hrs.)
• No history of disciplinary actions against license

There is also training provided for the systems use.

You will be under Maximus’s coverage so within these reviews you are not liable for anything because you are not diagnosing, seeing any patients, you are merely reviewing a file and providing your medical expert opinion.

Pay range and compensation package

The rates per case: Will discuss over a call.

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