Physician advisor/physician reviewer

AFMC is expanding its Medicaid peer review services, and we need your expertise. We’re looking for periodic physician reviewers in all specialties, especially cardiovascular surgery, psychology, orthopedics and oncology/hematology. Work at home on your own schedule and help make Arkansas’ health care system the best it can be. You determine the amount of time you want to spend on reviews — contact us to discuss remuneration. We offer fair compensation — and value your participation.

Reviewers are needed for:

  • Prior authorization of surgical procedures, children’s services, durable medical equipment and hyperalimentation
  • Review of inpatient services
  • Review of emergency services
  • Transplant review

Qualifications

  • Medical degree, state license and clinical experience in your specialty
  • Commitment to health care quality, service and integrity
  • Membership in AFMC

How reviews work

Many potential reviewers are unsure how the review process works. While there is a learning curve involved with using the review software, the reviews themselves tend to be straightforward. Here is an example of a review that an AFMC physician reviewer has handled in the past: “A 5-year-old child was admitted with symptoms of nausea and vomiting for 24 hours. Vital signs were normal, and abdominal exam was reported as ‘soft, with no specific tenderness.’ Mucous membranes were dry, but skin turgor was good. BUN was 25, electrolytes were normal.” Was acute care admission necessary for this child, or could a stay of less than 24 hours have been anticipated at the time of admission, allowing the care to be provided in an observation setting?

Reviewer comment

“The patient had only minimal dehydration findings at the time of admission, with no indication of serious infection or an acute abdominal process. A stay of less than 24 hours should have been anticipated at the time of admission. Therefore, the observation setting should have been used to provide initial care. The patient was adequately improved by the next morning to allow discharge to outpatient management within a 24-hour period. Thus, this admission to acute care was not necessary and should be denied.”

Join AFMC’s membership, study the manual and take the physician advisor test to get started.

To find out more, call Sally Johnson at 479-573-7632 or use the contact form below.

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AFMC respects your concerns about personal data protection and value our relationship with you. AFMC complies with federal and state laws, also an internal compliance program to protect the privacy of medical records, personal health information (PHI), and personal identifiable information (PII). AFMC implements a set of processes and system controls designed to ensure security of your privacy regulated by the Federal Information Security Management Act (FISMA). We put continuous efforts into monitoring potential risk by conducting audits, risk management, security planning and other FISMA related best practices. The Standards of Conduct articulates AFMC’s commitment to follow applicable federal and state laws and regulations, including the following: Title XVIII of the Social Security Act; Medicare regulations found in 42 C.F.R., sections 422 and 423; Patient Protection and Affordable Care Act (PPACA); Health Insurance Portability and Accountability Act (HIPAA) and as modified by HITECH Act; False Claims Act (FCA) and the Federal Criminal False Claims statutes; NIST Special Publication 800-26, Department of Defense (DoD) Policy 8500; Director of Central Intelligence Directive (DCID) 6/3; ISO/IEC Standard 17799; General Accounting Office (GAO) Federal Information System Controls Audit Manual (FISCAM); and Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) Core Security Requirements.

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