How to Build an Effective Medical Review Team 

Medical Review

It takes an effective medical review team to keep up with the demands of combating healthcare fraud, waste and abuse (FWA). But how do you find, recruit, hire and retain the right people to fill those nuanced and niche roles

Set your team up for success 

The 2022 Fraud, Waste & Abuse Report from Thomson Reuters shows medical review teams are challenged with increased workloads, strained budgets, retiring staff, and the effort needed to be current on new technologies and investigative techniques.  

Teams need to be robust to overcome these challenges and to effectively cover the work involved in medical review investigations. They also must stay current on clinical standards of care, rules and regulations, policy and new trends. 

To do all of this well, they need adequate staffing—which means managers need to hire and retain the right employees. But one common hiring challenge is the same in every industry: avoiding mis-hires in a tight labor market.  

Roles requiring specialized experience, like those in FWA review, are an additional stumbling block for recruiters due to required specialized experience, background and capabilities as well as potential licensure or certification. And quality medical review candidates are not simply a product of their skill assessments. They need to fit the culture, come from diverse backgrounds and have a willingness to continuously learn and adapt as the industry changes. 

When a team is not cohesive, diverse and supported, they are set up to fail—in the medical review industry, that means failing the mission to find, report and eliminate FWA. 

Organizations need to focus on hiring high-quality team members, building a diverse network of expertise and continuously supporting all employees for overall success. 

Hire, build and support 

A medical review team’s employment structure will vary depending on your organization’s scope and volume of work; full-time, in-house, part-time, contract, outsourced—sometimes all falling into one category, or made up of a dynamic mix.  

No matter the framework, if you hire effectively, build a diverse network and provide continuous support, you’ll have a team prepared to meet the challenges of medical integrity work. 

Beyond the Resume. Staffing an effective and robust medical review team takes time and thorough vetting. Hiring managers should be fully aware and knowledgeable about these roles and what is required to perform them successfully before reviewing resumes or interviewing begins. 

It’s also important to get to know potential employees beyond the resume. They may check all the boxes for the role they are applying for, have excellent references and interview well. Even so, they may not be the right person for that role. They may be overqualified, or clash with the culture. This doesn’t mean they aren’t right for another role or for another organization, but if you rush the hiring process and focus only on their resume, you could potentially have a mis-hire on your hands. 

A medical review assessment as part of the hiring process can show a candidate’s potential for success. One way is to have them review a mock chart to find errors and write a report. 

Networking and Recruiting Passive Candidates. As you build your team, you may encounter candidates through your search or networking activities that would be great employees—but perhaps they aren’t available, you don’t have an open role that fits them or it’s just not the right timing. These passive candidates become part of your network of potential team members if you stay connected and keep them top of mind when the timing and need are right. 

Embrace Differences. Diversity in demographics and clinical backgrounds is key to providing full-spectrum, quality medical review. Respecting the different knowledge of others, learning from their previous experience and listening to their point of view helps the team think outside the box and work cohesively toward their shared mission. 

The team could be made up of data analysts, investigators, coders, auditors, nurses, and physicians—all from different backgrounds, work environments and learning methodologies. At the end of the day, they all need to have the right credentials, experience and passion for health care as a diverse team. 

Continual Support Attracts and Retains. A robust medical review team needs consistent and continued support to stay at the top of their game. This includes clear and timely communication, opportunities for training and advancement, reminders of their shared mission and goals, and ensuring there is always adequate and qualified staff.  

A supportive environment attracts new and passive top talent, keeps current employees feeling valued and fosters pride. Your team will be recognized for staying current on laws and regulations, healthcare practices and excellence in medical review. 

We are here to help you build an effective medical review team 

Sometimes you simply need help with one piece of the puzzle, or don’t know how to get started. We are here to evaluate your medical review needs and connect the right candidates to the right roles. Contact us today to find out more. 

Intara Talent helps fill specialized public sector roles with highly qualified candidates. Contact us today to learn how we can help.