Anesthesiologist, Telecommute, Medical Review Stream Physician

Concentra

. Review health claims and provide medical interpretation and decisions about appropriateness of services provided by healthcare professionals .

Posted 11/4/2026contractRemote • New Mexico • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical review processes, including utilization review, quality assurance, and compliance with state and national guidelines. Possesses strong negotiation and communication skills essential for effective collaboration with healthcare professionals and regulatory agencies.

Highest-signal resume keywords

Board Certified MD Or DOCurrent Unrestricted Clinical LicensePost-Graduate Experience In Direct Patient CareKnowledge Of Current Practice StandardsExcellent Understanding Of Managed Care

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical InterpretationUtilization ReviewChart ReviewQuality AssurancePolicy DevelopmentReview ServicesTelephonic ConferencesTyped ReportsNegotiation SkillsConfidential Information Management

Soft Skills

Communication SkillsDiscretionProblem-Solving Skills

Tools & Technologies

Computer AccessPhone Access

Certifications & Qualifications

Board Certification By The American Board Of Medical SpecialtiesBoard Certification By The American Board Of Osteopathic SpecialtiesCurrent Errors And Omissions Liability Coverage

Industry Keywords

Healthcare ProfessionalsCredentialingFMLAWorkers’ Compensation ClaimsActive Medical PracticeRegulatory AgenciesManaged Care OrientationNational And State GuidelinesPeer-Reviewed LiteratureQuality Of Care

About the role

Key responsibilities & impact

Review health claims and provide medical interpretation and decisions about appropriateness of services provided by healthcare professionals
Review medical files and provide recommendations for utilization review, chart reviews, medical necessity, appropriateness of care, return to work, short- and long-term disability, FMLA, group health, and workers’ compensation claims
Meet with the Concentra Physician Review Medical Director regarding quality of care, credentialing, and state licensure issues when required
Maintain proper credentialing, state licenses, certifications, and other requirements
Return cases promptly with clear, concise, complete rationales and documented criteria
Contact providers by telephone and discuss disclaimers and appeal processes
Attend orientation and training
Identify and respond to quality assurance issues, complaints, regulatory issues, depositions, court appearances, and audits
Identify, critique, and use current criteria, national and state guidelines, professional association guidelines, and peer-reviewed literature
Provide requested review criteria copies to providers in a timely manner

Requirements

What you’ll need

Board certified MD or DO
Current, unrestricted clinical license(s), or a restricted license whose restrictions permit the job functions
Board certification by the American Board of Medical Specialties or American Board of Osteopathic Specialties required for MD or DO reviewer
Must be in active medical practice to perform appeals
Post-graduate experience in direct patient care
New Mexico MD license
Average 20 hours per week in active practice seeing patients
Excellent understanding of network services and managed care, utilization of services, credentialing, quality assurance, and policy development
Demonstrated computer skills and telephonic skills
Demonstrated ability to perform review services
Ability to work with regulatory agencies, carriers, employers, nurses, and healthcare professionals
No financial conflict of interest for physician-advisor medical direction
Current errors and omissions liability coverage for job duties and activities
Managed care orientation
Knowledge of current practice standards in specialty
Good negotiation and communication skills
Phone access and computer access to complete reviews
Ability to complete cases with typed reports within specified time frames
Ability to participate in telephonic conferences
Ongoing discretion and secure information management when handling confidential and sensitive information

Benefits

Comp & perks

Flexible schedule and caseload within a Monday–Friday work week and business hours
Compensation on a per-case basis as a 1099 independent contractor