Job Description

As a Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize your clinical expertise to review insurance appeals, as well as prospective and retrospective claims. The Physician Reviewer will interpret the medical necessity of services provided by healthcare professionals, ensuring compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care. MAJOR DUTIES AND RESPONSIBILITIES: Review all medical records and address each question posed by the client using client-specific criteria or other nationally recognized evidence-based criteria. Ensure that the rationale for each determination is clear, concise, and supported by adequate documentation. Identify, critique, and utilize current criteria and resources such as national, state, and professional association guidelines, as well as peer-reviewed literature, to support sound and objective decision-making. Avoid using case studies or cohorts with limited sample sizes for decision-making. Provide copies of any criteria used in a review along with the report in a timely manner. Return cases on or before the specified due date and time. Make telephone calls as mandated by state and/or client specifics. Maintain proper credentialing, state licenses, and any required certifications. Attend all required orientation and training sessions. Perform other duties as assigned, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits. Board certification and active practice are required. PLEASE BE AWARE: In the interest of security, Dane Street will never conduct interviews via text or request checks from candidates for any reason, including the purchase of equipment. Benefits include: Opportunity for supplemental income Flexible schedule and predictable work hours—choose services and case types, dictate volume, and conduct exams and reviews based on your availability No doctor/patient relationship is established; these are advisory-only opinions Enhance your industry expertise in medical necessity and utilization review/management Expand your credentials as an expert in IMEs and physician advisor services Streamlined case flow, prepped cases, transcription services at no cost, and a user-friendly work portal Dane Street supports all referral processes, scheduling, case preparation, client communication, and ensures timely report delivery. #J-18808-Ljbffr

Job Tags

Similar Jobs