Physician Reviewer

Employment Type: 1099 Independent Contractor Location Type: Remote Workplace: Remote Language: English Published: 2024-03-20

Position Overview

This telework opportunity provides the ability to customize your schedule and caseload within the week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent contractor.

Physician Specialties

• Radiation Oncology
• Cardiology
• Rheumatology
• Ophthalmology
• Otolaryngology
• OB/GYN
• Hematology/Oncology

Requirements

• Preferred candidates will hold a NM, TX, MN, and/or NC License.
• Maintain proper credentialing and state licenses.
• Maintain any special certifications or requirements necessary to perform the job.

Responsibilities

• Utilizes clinical expertise to review insurance appeals, as well as prospective and retrospective claims.
• Provides 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.
• 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 prior to the due time of the case.
• Returns cases on or before the due date and time.
• Makes telephone calls as mandated by the state and/or client specifics.
• 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.

Company Information

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.