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 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?

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 reviewer’s 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.

As a leading strategic partner to governments across the globe, Maximus helps improve the delivery of public services amid complex technology, health, economic, environmental, and social challenges. With a deep understanding of program service delivery, acute insights that achieve operational excellence, and an extensive awareness of the needs of the people being served, our employees advance the critical missions of our partners. Maximus delivers innovative business process management, impactful consulting services, and technology solutions that provide improved outcomes for the public and higher levels of productivity and efficiency of government-sponsored programs. For more information, visit maximus.com.