Job Opportunity: Utilization Review Physician

Company: Dane Street (Certified "Great Place to Work")

Employment Type: Contract (1099 Independent Contractor)

Location Type: Remote

Salary: Per-case basis

Position Overview

Dane Street is seeking a highly qualified Board Certified Orthopaedic Spine Surgeon, Neurosurgeon, Neurologist, or Physical Medicine & Rehabilitation physician to join our team for utilization reviews. This is a remote, telework opportunity offering flexibility in scheduling and caseload management within a standard Monday-Friday work week, while adhering to client-mandated turnaround times.

Job Summary

The Utilization Review Physician will leverage their clinical expertise to review workers' compensation claims. This involves interpreting the medical appropriateness of services rendered by other healthcare professionals, ensuring compliance with state regulations, nationally recognized evidence-based guidelines, client-specific policies, and URAC guidelines.

Responsibilities

• Review all medical records and address client-posed questions using state-mandated or nationally recognized evidence-based criteria.
• Ensure review rationales are clear, concise, and adequately supported by documentation.
• Meet or beat case due dates and times.
• Make telephone calls as required by state and/or client specifications.
• Maintain proper credentialing, state licenses, and any necessary special certifications.
• Attend all required orientation and training sessions.
• Perform other assigned duties, including identifying and responding to quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.
• Critically evaluate and utilize current criteria and resources (e.g., national, state, professional association guidelines, peer-reviewed literature) to support sound and objective decision-making. Refrain from using case studies or cohorts for decision-making due to limited sample sizes.
• Provide copies of criteria used in reviews with reports in a timely manner.

Requirements

• Board Certification in Orthopaedic Spine Surgery, Neurosurgery, Neurology, or Physical Medicine & Rehabilitation.
• Worker's Compensation experience is preferred but not required.
• Preferred candidates will hold a license in CA, GA, FL, IL, KY, LA, NV, or TX.

Application Instructions

• Please be aware that Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.

Company Information

Dane Street is a certified "Great Place to Work" company.

Published: 2024-02-02 Language: English