Physician Reviewer - Contract (Remote)

Position Overview

This telework opportunity offers flexibility in customizing your schedule and caseload within the week, while adhering to client-mandated turnaround times. As a 1099 independent contractor, our reviewers are compensated on a per-case basis.

Requirements

• Active Minnesota License: Candidates must hold an active license in Minnesota.
• Physician Specialties: Experience required in one or more of the following specialties:
  • Gastroenterology
  • Medical Oncology
  • Hematology
  • Otolaryngology
  • Psychiatry
  • Plastic Surgery
  • Pain Management
  • Ophthalmology
  • Orthopedic Surgery
  • OB/GYN
  • Neurology
  • Internal Medicine
  • General Surgery
  • Family Practice
  • Dermatology

Responsibilities

• Utilize clinical expertise to review insurance appeals, prospective, and retrospective claims.
• Provide interpretations of medical necessity for services rendered by other healthcare professionals.
• Ensure compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.
• Review all medical records and address client questions using client-specific or nationally recognized evidence-based criteria.
• Ensure review rationales are clear, concise, and adequately supported by documentation.
• Identify, critique, and utilize current criteria and resources (national, state, professional association guidelines, peer-reviewed literature) to support sound decision-making.
• Provide copies of criteria used in reviews with reports in a timely manner.
• Return cases on or before the due date and time.
• Make telephone calls as mandated by state and/or client specifics.
• Maintain proper credentialing, state licenses, and any necessary special certifications or requirements.
• Attend all required orientation and training sessions.
• Perform other assigned duties, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.

Application Instructions

• Employment Type: Contract
• Workplace: Remote
• Language: English

Company Information

• Company: Dane Street
• Security Notice: Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Additional Details

• Published: 2025-02-10
• Remote: Yes