Physician Reviewer

Employment Type: Contract Location Type: Remote Published: 2024-02-19 Language: English

Position Overview

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

Requirements

• Preferred candidates will hold a NV License.
• Maintain proper credentialing and state licenses.
• Maintain any special certifications or requirements necessary to perform the job.

Responsibilities

• Utilize clinical expertise to review insurance appeals, prospective and retrospective claims.
• Provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.
• Review all medical records and address each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria.
• Ensure the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision.
• Identify, critique, and utilize 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. Refrain from using case studies, cohorts, and the like to make decisions due to their limited sample sizes.
• Provide copies of any criteria utilized in a review with the report in a timely manner.
• Return cases on or before the due date and time.
• Make telephone calls as mandated by the state and/or client specifics.
• 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.

Company Information

Dane Street

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