Job Description
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, Family and Medical Leave Act (FMLA), Group health and workers' compensation claims. - Meets (when required) 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 iss...Medical, Medicine, Telecom, Rehab, Rehab, Medical Director, Healthcare
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