Responsible for assessing the delivery of medical services to determine if the care provided is appropriate, medically necessary, and of high quality. This includes examination of documents to see if patients are given care consistent with their needs as well as inputting of approved Guidelines and References. The review typically involves medical records abstracting, analysis and documentation based on client-specific guidelines and templates.
- Coordinates with the Production Supervisor and other Reviewers with regard to job assignment.
- Evaluates completeness of submitted documents and identifies missing information that may support completion of utilization review request.
- Constructs clear and accurate reviews of records that conform to the guidelines of each Client anddetermine if the care provided is appropriate, medically necessary, and of high quality.
- Applies ACOEM Guidelines and evidence-based references to certify or elevate to peer review requested procedures.Submits reviews for edit within a specified period.
- Meets a target production output or quota and a quality standard to be set by Management.
- Prepares impairment determination and/or impairment determination review according to Client guidelines.This includes analyzing the medical history in order to come up with impairment / disability ratings that comply with the reporting requirements and conform to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Permanent Disability Rating Schedule (PDRS), and Disability Evaluation under Social Security, as well as other state-mandated permanent impairment rating schedule.
- Responsible for disability reviews, research, deposition audit, editing and rating of IME, FCR, QME, AME & P&S reports.
- Prepares supplemental reports if there are clarifications regarding prior reports, if there are issues that needs to be addressed in the letter from DA, if there are additional records for review.
Qualifications:
- Graduate of Medicine (Licensed or Non-Licensed)
- With excellent oral and written communication skills
- Willing to work onsite at Upper McKinley , Taguig
