Physician Reviewer - Remote

Position Overview

This is a remote, 1099 independent contractor opportunity for a Physician Reviewer. You will have the flexibility to customize your schedule and caseload weekly, while adhering to client-mandated turnaround times. Compensation is on a per-case basis.

Physician Specialties

• Endocrinology
• Gastroenterology
• Dermatology
• Neurology
• Psychiatry
• Rheumatology
• Pediatrics
• Ophthalmology

Job Summary

The Physician Reviewer will utilize their clinical expertise to review insurance appeals and prospective and retrospective claims. You will provide interpretations of the medical necessity of services rendered by other healthcare professionals, ensuring compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.

Responsibilities

• Review all medical records and address client-posed questions using client-specific criteria or other nationally recognized evidence-based criteria.
• Ensure the rationale for determinations is clear, concise, and adequately supported by documentation.
• Identify, critique, and utilize current criteria and resources, including national, state, and professional association guidelines, and peer-reviewed literature for sound decision-making.
• Provide copies of utilized criteria with the report 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 special certifications or requirements.
• Attend all required orientation and training.
• Perform other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.

Requirements

• Active New Mexico (NM) License required.

Application Instructions

• PLEASE BE AWARE: 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

• Workplace: Remote
• Language: English
• Published: 2024-11-08