Physician - Infectious Diseases
McLean, VA 22102
| Specialty | Infectious Diseases |
|---|---|
| Profession | Physician |
Maximus is 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 enrollees 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 reviewers schedule
- $300 incentive Bonus to complete Projects Training
Deliverables:
- No direct defined evidence standard or guidelines
- Templates will be used to complete reviews
Provider Specialty
Pediatric Infectious Disease
Minimum Qualifications:
- Active MD/DO license
- 24 hours of direct patient care per week
- 5 years experience in appropriate specialty post training
- Board Certification
Rate Description of Service per case
The 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.
