- 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 in a timely manner
- Returns cases on or before the due date and time
- Makes telephone calls as mandated by the state and/or client specifics
- Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
- 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
-
Physician Reviewer
1 week ago
Dane Street West Palm Beach, United StatesDane Street, a certified "Great Place to Work'' company, is searching for Board Certified Internal Medicine physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to customize your schedule and caseload within a standard Monday - Frida ...
-
Physician Reviewer
4 days ago
Dane Street, LLC West Palm Beach, United StatesJob Description · Job DescriptionDane Street, a certified "Great Place to Work" company, is in search of a Board Certified Oncologist, Interventional Radiologist, Pediatric Oncologist, Radiation Oncologist, Hematologist/Oncologist, and Medical Geneticist, physician to process Uti ...
-
Physician Reviewer
5 days ago
Dane Street, LLC West Palm Beach, United StatesJob Description · Job DescriptionDane Street, a certified "Great Place to Work'' company, is searching for Board Certified Internal Medicine physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to customize your schedule and caseload ...
-
Physician Reviewer: Physical Medicine
4 days ago
Dane Street, LLC West Palm Beach, United StatesJob Description · Job DescriptionThis 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. · JOB SU ...
-
Physician Reviewer: Orthopedic Surgery
4 days ago
Dane Street, LLC West Palm Beach, United StatesJob Description · Job DescriptionThis 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. · Prefer ...
-
Physician Reviewer: Neurological Surgery
4 days ago
Dane Street, LLC West Palm Beach, United StatesJob Description · Job DescriptionThis 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. · Prefer ...
-
Physician Reviewer: Orthopedic Surgery
1 week ago
Dane Street West Palm Beach, United StatesThis 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. · Job Summary · Preferred candidates will ...
-
Physician Reviewer: Physical Medicine
1 week ago
Dane Street, LLC West Palm Beach, United States ContractThis 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. · JOB SUMMARY · Utilizes clinical experti ...
-
Scribe
4 days ago
The Paley Institute West Palm Beach, United States**JOB SUMMARY** · Follows physicians through his or her workday and chart patient encounters in real-time using a medical office's Electronic Health Record and existing templates. · **ESSENTIAL DUTIES AND RESPONSIBILITIES** · Chart patient encounters in real-time during office vi ...
-
Practice Coordinator
3 days ago
The Paley Institute West Palm Beach, United States**Summary**: · The Medical Office Coordinator is responsible for greeting patients, answering phones and scheduling appointments. The collection of accurate patient demographics, insurance verification, referral processing, and various other areas of data entry. Coordinates the d ...
-
Lpn : 7am-7pm & 7pm-7am
4 days ago
Anthem Lakes Atlantic Beach, United StatesJob Summary: Provides residents with nursing services as outlined in the personal service plans; promotes wellness, and administers medications and treatments in accordance with physicians' orders and within state licensure regulations. · Essential Functions: · 1. Assists in main ...
-
Health Information Manager
1 day ago
Fleet Landing Atlantic Beach, United States Full time**Make Fleet Landing the next chapter in your story.** · Filled with great stories and storytellers, Fleet Landing can change the story of your life. Find a career here, and you can add depth and meaning to your story beyond what you can imagine. · **Our Story** · Integrity and p ...
-
Regional Manager Front Desk
1 week ago
MD Now West Palm Beach, United StatesThis position is incentive eligible. · **Introduction**: · Do you have the career opportunities as a Regional Manager Front Desk you want with your current employer? We have an exciting opportunity for you to join CareNow which is part of the nation's leading provider of healthca ...
-
Wellstone Regional Hospital West Palm Beach, United States**Responsibilities**: · **Registered Nurse (RN) Opportunity - Night Shift** · This full-time opportunity offers 36-hours per week, full benefits, and a night shift schedule. There is an opportunity for overtime and to cover various shifts if interested. · **Wellington Regional Me ...
-
MASC Medical West Palm Beach, United StatesFunctional Medicine Physician $260k plus productivity bonus · (Primary Care, Integrative Medicine, Dermatology) · West Palm Beach, FL · Our Client is seeking an experienced and dedicated Functional Medicine Physician to join their team. You will provide direct patient care, discu ...
-
Master Injector $180k plus productivity
6 days ago
MASC Medical West Palm Beach, United StatesMaster Injector $180k plus productivity bonus · (NP/PA) · West Palm Beach, FL · Our Client is seeking an experienced and dedicated Master Injector Nurse Practitioner or Physician Assistant to join their team. The ideal candidate must have experience with fillers and injectables. ...
-
HRT Provider
2 days ago
MASC Medical West Palm Beach, United StatesHRT Provider $150K · (NP/PA) · West Palm Beach, FL · Our Client is seeking an experienced and dedicated HRT Nurse Practitioner or Physician Assistant to join their team. The ideal candidate must have experience in providing hormone replacement therapy modules and stem cell therap ...
-
RN Case Manager Full Time Days
1 day ago
Palm Beach Gardens Medical Center Palm Beach Gardens, United States Full timeUp to $10,000 Sign-On bonus for experienced Registered Nurse / RN · GENERAL SUMMARY: · The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilizat ...
-
Physical Therapist Outpatient Full Time Days
6 hours ago
Palm Beach Gardens Medical Center Palm Beach Gardens, United States Full timeUp to $8,000 Sign On Bonus available based on experience Summary · Evaluates, plans and implements specific treatment programs for individual patients according to the principles and practices of physical therapy. Functions as an interdisciplinary team member providing patient a ...
-
Manager in Training
1 day ago
EAST FL DIVISION OFFICE - APP Atlantis, United StatesThis position is incentive eligible. · **Introduction**: · Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family Jump-start your career as a Manager in Training - Patient Experie ...
Physician Reviewer - West Palm Beach, United States - Dane Street
Description
Dane Street, a certified "Great Place to Work" company, is in search of a Board Certified Oncologist, Interventional Radiologist, Pediatric Oncologist, Radiation Oncologist, Hematologist/Oncologist, and Medical Geneticist, physician to process Utilization Reviews / Group Health Appeals Reviews. 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.
Preferred candidates will hold a TX license. Other preferred licenses are MN, IL, and CA.
Job Summary
Utilizes clinical expertise, and reviews insurance appeals, prospective and retrospective claims. The physician reviewer will 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.
MAJOR DUTIES AND RESPONSIBILITIES:
