Infectious Diseases, Pediatric Infectious Disease MD/DO
Job DescriptionMaximus is looking for a 100% Remote, 1099, Pediatric Infectious Disease MD/DO ReviewerDescription: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/InvestigationalSpecialty Driven-Expert within the Specialty RequestedLayman 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 portalTraining:Review Training Trainer will work closely with reviewer for the first 3-5 casesScheduled Training- based on reviewers schedule$300 incentive Bonus to complete Projects TrainingDeliverables:No direct defined evidence standard or guidelinesTemplates will be used to complete reviewsProvider SpecialtyPediatric Infectious DiseaseMinimum Qualifications:Active MD/DO license24 hours of direct patient care per week5 years experience in appropriate specialty post trainingBoard CertificationRate Description of Service per caseThe rates per caseMedical Necessity Review: Standard CaseMost common type of review30 45 minutes to complete5 7 days to turnaround$150.00 per reviewMedical Necessity Review: Expedited CaseSickest patients 24-hour turnaround45 min - 1 hour to complete$250.00 per reviewExperimental/Investigational Reviews: Standard CaseSecond most common review1-2 hours to complete (based on experience)5 - 7-day turnaround$300.00 per reviewVolume: Varies based on needExperimental/Investigational Reviews: Expedited CaseSickest of patients 24-hour turnaround1-2 hours to complete (based on experience)$400.00 per reviewFor more information about Maximus, please visit https://maximus.com/ to learn more about our organization.