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- Reviews all medical records and addresses each question posed utilizing client-specific criteria or other nationally recognized evidence-based criteria
- Ensures a clear rationale for determination that is concise and contains adequate supporting documentation to substantiate the decision
- Identifies and employs 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 a report and copies of any criteria utilized within the review promptly
- Returns cases on or before the due date and time specified
- Completes calls/call attempts as mandated by the state and/or client specifics
- Maintains proper credentialing, required licenses, and any special certifications and adheres to requirements necessary to perform in the role of Physician Reviewer/Advisor
- Attends required orientation and training
- Performs other duties as assigned including identifying and responding to potential quality assurance issues, complaints, and regulatory issues.
- Robust opportunity for supplemental income
- Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability
- No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions
- Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise
- Expanded credentials as an expert in Independent Medical Exams and physician advisor services
- Streamlined case flow and user-friendly work portal
Physician Reviewer, Neurological Surgery - Nevada, United States - Dane Street
Description
This is a telework opportunity for supplemental income for physicians providing a caseload customized to your schedule. Our physician panel is comprised of independent contract reviewers compensated on a per-case basis.Job Summary
Preferred candidates will hold Nevada Medical License (M.D., D.O.)
Physician Reviewer/Advisor utilizes clinical expertise to review, provide interpretation of clinical treatment guidelines and opine on the medical necessity of services/treatment proposed or provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.
MAJOR DUTIES AND RESPONSIBILITIES:
Benefits