FHAS, LLC
Responsible for reviewing medical case files and making medical determinations related to medical necessity, appropriateness, experimental treatments, and administrative or legal issues. Reviews and analyzes Federal and State laws, regulations, and applicable policy guides, completing evaluations within regulatory timeframes.
Key Responsibilities
- • Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA).
- • Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
- • Completes and evaluates the review process in a regulatory timeframe.
Required
- • Successful completion of a Residency or Fellowship Program
- • Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
- • License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
- • License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
- • For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
- • Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
- • 5-years or more post graduate clinical experience in direct patient care
- • Experience providing direct patient care within the past 3 years, if performing external reviews
Company Overview
Industry: Healthcare Technology
Company Size: 500-1,000 employees
Founded: 2015
Headquarters: San Francisco, CA
Company Links
Key Contacts
Contact information not available
About the Company
Leading healthcare technology company focused on improving patient outcomes through innovative digital solutions. We're transforming the way healthcare is delivered with cutting-edge technology and data-driven insights. Our platform serves over 10,000 healthcare professionals and has processed millions of patient interactions.
Recent News & Updates
Physician Peer Reviewer – Multiple Specialties in Texas and/or New Mexico
Overview
Federal Hearings and Appeals Services (FHAS) is a URAC-accredited Independent Medical Review Organization (IRO) with Health Utilization Management (HUM) accreditation. For the past 30 years, FHAS has provided external peer review services to healthcare organizations, government agencies, insurance companies, and legal entities.
FHAS is currently expanding its elite panel of physicians licensed in the state of Indiana and Nevada to assist with independent review claims and appeals in any of the following specialties:
Addiction Medicine, Allergy & Immunology, Anesthesiology, Cardiovascular Disease, Child & Adolescent Psychiatry, Chiropractic Medicine, Dentist, Dermatology, Emergency Medicine, Endocrinology, Diabetes, & Metabolism, Family Medicine, Gastroenterology, Internal Medicine, Interventional Cardiology, Interventional Radiology & Diagnostic Radiology, Medical Genetics & Genomics, Medical Oncology, Nephrology, Neurological Surgery, Neurology, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Pain Medicine, Pathology, Pediatrics, Pediatric Cardiology, Pediatric Critical Care Medicine, Developmental-Behavioral Pediatrics, Pediatric Emergency Medicine, Pediatric Gastroenterology, Pediatric Nephrology, Physical Medicine & Rehabilitation, Plastic Surgery, Psychiatry, Psychology *PhD, Radiation Oncology, Radiology, Rheumatology, Sleep Medicine, Thoracic & Cardiac Surgery, Transplant Hepatology, Undersea & Hyperbaric Medicine
Description
- Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA).
- Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
- Completes and evaluates the review process in a regulatory timeframe.
Work Experience Requirements
- Successful completion of a Residency or Fellowship Program
- Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
- License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
- License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
- For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
- Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
- 5-years or more post graduate clinical experience in direct patient care
- Experience providing direct patient care within the past 3 years, if performing external reviews
Job Type
Contract
Work Location
Remote
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