We are looking for a 100% Remote, 1099, Hematology Oncology MD/DO Reviewer
Description:
· Medical Expert Reviewer-Medical Expert Judgement Reviews determining final decision based off enrollee’s denial of treatment-coverage denied by the CA DMHC.
· Reviews-are based off Medical Necessity and Experimental/Investigational
· Specialty Driven-Expert within the Specialty Requested
Layman Terms:
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 CA DMHC (Department of Managed Health Care) or not. The reviews are based on two main factors: medical necessity (whether the treatment is necessary for the patient's health) and whether the treatment is experimental or investigational.
Systems and Tools:·
Expert Reviewers must use their own personal computer to access a web-based portal
Training:·
Review Training –Trainer will work closely with reviewer for the first 3-5 cases ·
Scheduled Training- based on reviewer’s schedule
·
Deliverables:·
No direct defined evidence standard or guidelines·
Templates will be used to complete reviews
Provider Specialty
Hematology Oncology
Minimum Qualifications:
•Active license
•24 hours of direct patient care per week
•5 years’ experience in appropriate specialty post training
•Board Certification
Rates per case
Medical Necessity Review: Standard Case
Most common type of review
30 – 45 minutes to complete
5 – 7 days to turnaround
$150.00 per review
Medical Necessity Review: Expedited Case
Sickest patients 24-hour turnaround
45 min - 1 hour to complete
$250.00 per review
Experimental/Investigational Reviews: Standard Case
Second most common review
1-2 hours to complete (based on experience)
5 - 7-day turnaround
$300.00 per review
Volume: Varies based on need
Experimental/Investigational Reviews: Expedited Case
Sickest of patients 24-hour turnaround
1-2 hours to complete (based on experience)
$400.00 per review
For more information about Maximus, please visit https://maximus.com/ to learn more about our organization.
