Pediatrician

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We are looking for a 100% Remote, 1099, Pediatric Infectious Disease 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

Pediatric Infectious Disease

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.

Keith Stewart

Clinical Recruiter

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider and Consulting

• Industries

  Hospitals and Health Care and Government Administration

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