Physician Reviewer - Organ Transplant

Position Overview

This is a telework opportunity for a Physician Reviewer specializing in Organ Transplant (Solid organ and BMT...Lung, Heart, Kidney, Liver). Reviewers are compensated on a per-case basis as a 1099 independent contractor. This role allows for schedule and caseload customization within the week, while adhering to client-mandated turnaround times.

Job Summary

Utilizes clinical expertise to review insurance appeals and prospective and retrospective claims. The physician reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals, ensuring compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.

Responsibilities

• Reviews all medical records and addresses each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria.
• Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision.
• Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews.
• Refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes.
• Provides copies of any criteria utilized in a review with the report.
• Returns cases on or before the due date and time.
• Makes telephone calls as mandated by state and/or client specifics.
• Maintains proper credentialing, state licenses, and any special certifications or requirements necessary to perform the job.
• Attends all required orientation and training.
• Performs other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.

Requirements

• Physician Specialty: Organ Transplant (Solid organ and BMT...Lung, Heart, Kidney, Liver)
• Maintains proper credentialing and state licenses.
• Maintains any special certifications or requirements necessary to perform the job.

Application Instructions

• Important Security Notice: In the interest of the security of both parties, please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Company Information

• Department: Networking- Physician Recruitment
• Published: 2024-11-08

Employment Details

• Employment Type: (Not specified)
• Location Type: Remote
• Workplace: Remote
• Language: en
• Remote: Yes