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.
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.
- Review Training –Trainer will work closely with reviewer for the first 3-5 cases.
- Scheduled Training- based on reviewer’s schedule.
- No direct defined evidence standard or guidelines.
- Templates will be used to complete reviews.
Provider Specialty
Minimum Qualifications
- 24 hours of direct patient care per week.
- 5 years’ experience in appropriate specialty post training.
Medical Necessity Review: Standard Case
Most common type of review.
30 – 45 minutes to complete.
5 – 7 days to turnaround.
Medical Necessity Review: Expedited Case
Sickest patients 24-hour turnaround.
45 min - 1 hour to complete.
Experimental/Investigational Reviews: Standard Case
Second most common review.
1-2 hours to complete (based on experience).
5 - 7-day turnaround.
Volume: Varies based on need.
Experimental/Investigational Reviews: Expedited Case
Sickest of patients 24-hour turnaround.
1-2 hours to complete (based on experience).
For more information about Maximus, please visit to learn more about our organization.
#J-18808-Ljbffr