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: 

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.