Job Specific Duties and Responsibilities: Provide medical consultation and case review evaluations on Workers Compensation cases, primarily for the Department of Labor (DOL) on Federal Employee Compensation Act cases. The Joint Commission Quality and Safety Completes training on DFEC policy, procedures, and regulations prior to performing case reviews. Performs medical consultation in accordance with FOHs policy and standard operating procedures. Service Operations Supports the medical and consultative needs for the Department of Labor (DOL) and other federal agency (when requested) workers compensation programs. Evaluates workers compensation case files, interprets medical reports, evaluates medical evidence and test results, translates technical medical language, and provides guidance or instruction to customer agencies regarding general medical issues that pertain to workers compensation cases. Performs DOL FECA case reviews in accordance with DOL FECA regulations. The type of case reviews include: o Medical/Surgical Review Routine: This category will cover review for routine medical/surgical authorization or opinion on issues including, but not limited to, extended physical therapy, consequential condition causal relationship, etc. Provides a written medical opinion for medical/surgical review cases within 10 business days of receipt. o Medical/Surgical Review Complex: This category will cover review for medical/surgical authorization or opinion on complex issues including, but not limited to, destructive procedures, and complex medical conditions (cardiopulmonary, psychiatric, etc.). Provides written medical opinion response for this case type within 20 business days of receipt. o Impairment Rating (Routine and Complex): Provides medical consultation on impairment ratings for cases involving orthopedic issues, musculoskeletal 2 | JSPD Improving the health, safety, and productivity of our federal employees. injuries, and organ dysfunction. Impairment rating evaluations are conducted in accordance with the AMA Guides to the Evaluation of Permanent Impairment (6th edition). Provides a written opinion for impairment rating case reviews within 10 or 20 business days of receipt for simple and complex cases, respectively. o Death Claim Review: Evaluate medical information in death claims for causal relationship. Provides a written opinion for this case type within 10 business days of receipt. o Expedited Review Performs reviews on catastrophic injury cases or other instances in which an expedited response is required in order to approve care. Provide written medical opinions for this case type within 3 business days of receipt. Demonstrates a strong level of technical expertise in performing medical consultation for workers compensation cases and an ability to work and communicate orally and in writing. Renders medical opinions with a reasonable degree of medical certainty and provides clear written rationale for these medical opinions. Possesses a strong technical knowledge regarding federal safety and health and workers compensation regulations. Demonstrates a high level of professional conduct. Provides expert medical advice and consultation to FOH and its federal customer agencies on workers compensation issues. Clinical May be required to conduct hands-on examinations (if so privileged by FOH), render a professional opinion as it relates to work clearances or recommendations consistent with the examination findings and established physical qualifications. Procurement Submit monthly billing in the specified format and by specified deadline
Minimum Requirements/Knowledge/Skills: Active medical practice with a minimum of 240 hours of direct patient care per year in the clinical specialty for which case reviews will be conducted in order to participate as a medical provider under the Federal Employees' Compensation Act. Must possess expert understanding of Federal safety and health regulations, and experience reviewing workers compensation cases. A broad knowledge of requirements of federal workers compensation is desired. Demonstrated experience in dealing with various size organizations representing widely divergent backgrounds, points of view, and levels of authority (i.e. labor union and management issues relating to workers compensation). Certain positions may require FAA flight surgeon certification or MROCC certification. Maintain current BLS certification, if conducting direct patient evaluation. Basic computer skill proficiency (e.g., MS Word, Excel, MS Access, and Outlook) required. Must possess excellent written and oral communication skills.
Licensed physician (MD or DO) degree with specialty board-certification in their area of subject matter expertise by one of the medical specialty Boards recognized by the American Board of Medical Specialties, or by the American Osteopathic Association. License must be a valid state license to practice medicine from one of the 50 states or the District of Columbia without disciplinary actions present or pending. A minimum of two (2) years of clinical experience in the specialty for workers compensation reviews will be conducted. Advanced training in Public Health is desired with a previous experience as a medical consultant for a Federal agency
- Basic Life Support
- Claim Processing
- Clinical Works
- Health Care