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 (1099) compensated on a per-case basis.
Preferred candidates will hold Nevada Medical License (M.D., D.O.)
JOB SUMMARY
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:
- 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.
PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment.