- Reviews all medical records and addresses each question posed by the client utilizing state-mandated 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
- Returns cases on or before the due date and time
- 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
- 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
- Conducts Independent Medical Exams in a clean, safe, professional manner and setting
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Children's Hospital of Orange County California, United States Full timeWork Location · Orange, California Work Shift · Day – 08hrs (United States of America) Why CHOC? · At CHOC, we strive to be the leading destination of children's health by providing exceptional and innovative care. We are responsible for the overall health of our community's ...
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Physician Reviewer-Internal, Family, Physical - California, United States - Dane Street, LLC
Description
Dane Street, a certified "Great Place to Work'' company, is searching for Board Certified Internal Medicine, Family Practice, Physical Medicine & Rehabilitation, Occupational Medicine, Sports Medicine, and General 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 - Friday work week while maintaining client-mandated turnaround times. We will reach out when we have an IME or Peer Review in your jurisdiction/area to schedule or assign a case. Our reviewers are compensated on a per-case basis as a 1099 independent contractor.
Physician Specialties: Internal Medicine, Family Practice, Physical Medicine & Rehabilitation, Occupational Medicine, Sports Medicine, General Medicine
Physicians Located in the following areas: Downey, CA, Anaheim, CA, Glendale, CA, Long Beach, CA, Pasadena, CA, Los Angeles, CA
JOB SUMMARY:
Utilizes clinical expertise, and reviews disability claims by providing an interpretation of the medical appropriateness of services provided by other healthcare professionals in compliance with state regulations and guidelines, nationally recognized evidence-based guidelines, client-specifics, policies, procedures, performance standards, and URAC guidelines.
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.
