Infectious Diseases, Pediatric Infectious Disease MD/DO

Maximus is looking for a 100% Remote, 1099, Pediatric Infectious Disease MD/DO Reviewer

Description:

\n
• Medical Expert Reviewer-Medical Expert Judgement Reviews determining final decision based off enrollees denial of treatment-coverage denied by the CA DMHC.
\n
• Reviews-are based off Medical Necessity and Experimental/Investigational
\n
• Specialty Driven-Expert within the Specialty Requested
\n

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:

\n
• Expert Reviewers must use their own personal computer to access a web-based portal
\n

Training:

\n
• Review Training Trainer will work closely with reviewer for the first 3-5 cases
\n
• Scheduled Training- based on reviewers schedule
\n
• $300 incentive Bonus to complete Projects Training
\n

Deliverables:

\n
• No direct defined evidence standard or guidelines
\n
• Templates will be used to complete reviews
\n

Provider Specialty

Pediatric Infectious Disease

Minimum Qualifications:

\n
• Active MD/DO license
\n
• 24 hours of direct patient care per week
\n
• 5 years experience in appropriate specialty post training
\n
• Board Certification
\n

Rate Description of Service per case

The rates per case

Medical Necessity Review: Standard Case

\n
• Most common type of review
\n
• 30 45 minutes to complete
\n
• 5 7 days to turnaround
\n
• $150.00 per review
\n

Medical Necessity Review: Expedited Case

\n
• Sickest patients 24-hour turnaround
\n
• 45 min - 1 hour to complete
\n
• $250.00 per review
\n

Experimental/Investigational Reviews: Standard Case

\n
• Second most common review
\n
• 1-2 hours to complete (based on experience)
\n
• 5 - 7-day turnaround
\n
• $300.00 per review
\n
• Volume: Varies based on need
\n

Experimental/Investigational Reviews: Expedited Case

\n
• Sickest of patients 24-hour turnaround
\n
• 1-2 hours to complete (based on experience)
\n
• $400.00 per review
\n

For more information about Maximus, please visit https://maximus.com/ to learn more about our organization.