Pediatric Infectious Disease MD/DO

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: ?

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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.