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Pediatrician
Maximus
- New York, New York, United States
- New York, New York, United States
Über
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. S ystems 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 P
rovider Specialty Pediatric Infectious Disease M inimum Qualifications: •24 hours of direct patient care per week •5 years’ experience in appropriate specialty post training M edical Necessity Review: Standard Case Most common type of review 30 – 45 minutes to complete 5 – 7 days to turnaround M edical Necessity Review: Expedited Case Sickest patients 24-hour turnaround 45 min - 1 hour to complete E xperimental/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 E xperimental/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 https://maximus.com/ 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 Referrals increase your chances of interviewing at Maximus by 2x Sign in to set job alerts for “Pediatrician” roles.
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Sprachkenntnisse
- English
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