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Pediatric Infectious Disease MD / DO

Pediatric Infectious Disease MD / DO

Maximus Federal & VESMcLean, VA, US
17 hours ago
Job type
  • Full-time
Job description

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.

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    Pediatric Disease • McLean, VA, US

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