- 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
6 days ago
Dane Street, LLC Albuquerque, 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 ...
-
Board Certified Physician Reviewers
6 days ago
Dane Street, LLC Albuquerque, United StatesJob Description · Job DescriptionDane Street is looking for individuals to conduct Group Health reviews. This review will include a clinical summary, potential calls to the treating providers, and responses to questions posed. · The average length of time to review each case is b ...
-
Nurse Practitioner
5 days ago
MediTelecare New Mexico, United StatesConduct live clinical assessments of patients, providing treatment protocols, prescribing or recommending behavioral medications and providing medication management in long term care facilities · Work closely with our collaborating psychiatrists where required by state law or ind ...
-
The University of New Mexico Albuquerque, United States Full timePosition Summary · The University of New Mexico, Department of Emergency Medicine is seeking a certified Registered Diagnostic Medical Sonographer (RDMS) in Abdomen and Obstetrics and Gynecology . This faculty will serve as an Assistant Ultrasound Director to teach point of ca ...
-
Nurse Practitioner or Physician Assistant
6 days ago
Curana Health Albuquerque, NM, United States Part timeJob Details Job Location : Albuquerque, NM - Albuquerque, NM · Position Type : Part Time · Salary Range : Undisclosed Description Curana Health is a provider-led , primary and post acute organization focused on senior living communities and senior living residents. We ar ...
-
Family Nurse Practitioner
1 week ago
Cibola General Hospital Albuquerque, United StatesJOB SUMMARY · The duties of a Nurse Practitioner - APRN mid-level provider include, but are not limited to, providing accurate assessment, diagnosis, treatment, consultation, education and follow-up care to patients ranging in age from newborns to geriatric OR 18 yrs. of age to g ...
-
Medical Assistant
1 week ago
Loyal Source Government Services Albuquerque, United StatesThis position has the ability to genuinely serve our Veterans on every level, including the ability to enhance patient satisfaction and increase office efficiency. You must be able to positively impact our Veteran clients, coworkers, and the clinic as a whole. We have found that ...
-
Registered Nurse, Dialysis PRN
2 days ago
Kindred Hospital Albuquerque Albuquerque, United StatesRegistered Nurse, Dialysis PRN · Albuquerque, New Mexico Facility Kindred Hospital Albuquerque · Req ID Post Date 04/30/2024 · Description · ScionHealth is committed to a culture of service excellence as demonstrated by our employees' adherence to the service excellence prin ...
-
Respiratory Therapist
1 week ago
Ardent Health Services Albuquerque, United StatesOverview · Join our team as a night shift, PRN, Registered Respiratory Therapist (RRT) in Albuquerque, NM. · Fulfilling your purpose begins here: · People First, Always. Here's how we take care of our people: · * Competitive salaries, support teams and growth opportunities. · You ...
-
Surgical Scrub Tech
5 days ago
Lovelace Women's Hospital Alameda, United StatesOverview · Join our team as a day shift, PRN, Endoscopy Lab Surgical Scrub Tech in Albuquerque, NM. · Fulfilling your purpose begins here: · People First, Always. Here's how we take care of our people: · Competitive salaries, support teams and growth opportunities. · Your tea ...
-
Registered Respiratory Therapist
1 week ago
Lovelace Health System Albuquerque, United StatesOverviewJoin our team as a day shift, full-time, Pulmonary Registered Respiratory Therapist (RRT) in Albuquerque, NM. · Fulfilling your purpose begins here: · People First, Always. Here's how we take care of our people: · Medical, vision, dental health insurance, health saving ...
-
Surgical Scrub Tech Endoscopy
1 week ago
Lovelace Women's Hospital Careers Albuquerque, NM, United States Full timeOverview · Surgical Scrub Tech, Endoscopy Lab, Full-Time, Days · Join our Lovelace Women's Hospital team as a Surgical Scrub Tech · Lovelace Women's Hospital, the first and only hospital in New Mexico dedicated to women's health, offers a 53-bed advanced neonatal intensive car ...
-
Surgical Scrub Tech
5 days ago
Lovelace Women's Hospital Alameda, United StatesOverview · Join our team as a part-time Surgical Scrub Tech in Albuquerque, NM. · Fulfilling your purpose begins here: · People First, Always. Here's how we take care of our people: · Medical, vision, dental health insurance, health savings account / flexible spending, competi ...
-
Customer Service Representative
1 week ago
EPITEC Albuquerque, United StatesJOB SUMMARY: As a Customer Service Representative in this training role, you'll learn to perform essential functions related to managing contractual relationships with healthcare providers. Your responsibilities include resolving practitioner issues, ensuring smooth network opera ...
-
Respiratory Therapist
2 weeks ago
Lovelace Women's Hospital Albuquerque, United States PRN ReliefOverview · Join our team as a night shift, PRN, Registered Respiratory Therapist (RRT) in Albuquerque, NM. · Fulfilling your purpose begins here: · People First, Always. Here's how we take care of our people: · Competitive salaries, support teams and growth opportunities. · Yo ...
-
NM LTC Pharmacist Opportunity
3 weeks ago
Soliant Albuquerque, United StatesMinimum 1+ years pharmacy experience required. · Join our team as a Pharmacist at a closed-door, long-term care pharmacy in Albuquerque, New Mexico. This position offers immediate employment with the possibility of a contract extension or permanent placement. · As a Pharmacist, y ...
-
Behavioral Medical Director
1 week ago
UnitedHealth Group Albuquerque, United States Full timeor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. · The Behavioral Medical Director position is r ...
-
Echo Tech
2 weeks ago
Lovelace Women's Hospital Albuquerque, United States Full timeOverview · You may be eligible for a sign-on bonus · Join our team as a day shift, full-time, Echocardiography (Echo) Lab Tech in Albuquerque, NM. · Fulfilling your purpose begins here: · People First, Always. Here's how we take care of our people: · Medical, vision, dental he ...
-
Registered Respiratory Therapist
2 days ago
Lovelace Medical Center Albuquerque, United StatesOverview · Join our team as a day shift, full-time, Registered Respiratory Therapist (RRT) in Albuquerque, NM. · Fulfilling your purpose begins here: · People First, Always. Here's how we take care of our people: · Medical, vision, dental health insurance, health savings accoun ...
-
Surgical Scrub Tech
1 week ago
Lovelace Women's Hospital Albuquerque, United StatesOverview · Join our team as a · part -time · Surgical Scrub Tech in · Albuquerque, NM · . · Fulf · illing your purpose begins here: · People First, · Always · . · Here's · how we take care of our people: · Medical, vision, dental health insurance, health savings account / flexibl ...
Physician Reviewer - Albuquerque, United States - Dane Street
Description
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 NM License.
Physician Specialties:
Endocrinology, Gastroenterology, Dermatology, Medical Oncology, Psychiatry, Pulmonary Disease
JOB SUMMARY
Utilizes clinical expertise, and reviews insurance appeals, and 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:
PLEASE BE AWARE:
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.
