Physician Reviewer: Orthopedic Surgery - Spine Surgeon Job at Dane Street, LLC, West Palm Beach, FL

K3k3ZmhDVzh0STUrWU5DWUZrd240NDhQSEE9PQ==
  • Dane Street, LLC
  • West Palm Beach, FL

Job 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 TX license.

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:

  • 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

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.

Job Tags

Contract work, For contractors, Remote job,

Similar Jobs

Verizon

Consultant Job at Verizon

 ...Verizon, we power and empower how people live, work and play by connecting them to what...  ...What were looking for You are a true consultative salesperson, who is energized by meeting...  ...In this remote role, you'll work from home with occasional in-person trainings and meetings... 

DSV - Global Transport and Logistics

Freight Forwarder - Ocean Import Job at DSV - Global Transport and Logistics

 ...customers. Read more at Location: USA - Plainfield, 2363 East Perry Road Division:Air & Sea Job Posting Title: Freight Forwarder - Ocean Import Time Type: Full Time Summary The primary duty of a Freight Forwarder is to review and process shipment... 

Dynamic Systems Technology, Inc.

Program Manager - IMCOM Systems Navigators Job at Dynamic Systems Technology, Inc.

 ...Navigators and ACS Compliance Specialists (SNACS) Support Services contract. The PM serves as the primary point of contact between DysTech...  ...Experience managing geographically dispersed teams and remote personnel Work Environment & Location Program management... 

Domino's Corporate

Class B CDL Driver - Straight Truck Driver Job at Domino's Corporate

 ...PIZZA AND MORE POSSIBLE Be a part of the world's #1 Pizza company! Job Description Dominos Class B CDL Straight Truck Driver safely drives the company commercial vehicle on established routes to deliver and unload products to Dominos Pizza store locations... 

Infinity Quest UK

ODI ETL developer Job at Infinity Quest UK

 ...We are seeking a talented ODI Developer with IDMC knowledge to design, build, and optimize enterprise data integration solutions. The role involves migrating ODI-based ETL pipelines to Informatica IDMC for modern cloud-native data integration, governance, and quality...