This telework opportunity allows you 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.
Candidates must hold an active NM License.
Physician Specialties: Endocrinology, Gastroenterology, Dermatology, Neurology, Psychiatry, Rheumatology, Pediatrics, Ophthalmology.
Utilizes clinical expertise, 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:
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.
Dane Street is a fast-paced, Inc. 500 Company specializing in independent medical examinations (IME) and peer review services for the insurance and claims management industry. The company processes over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health carriers, as well as Third-Party Administrators and Managed Care Organizations. They provide customized IME and Peer Review programs that help clients make appropriate medical determinations as part of the claims management process. With a high-performance culture, Dane Street serves employers, pharmacy benefit managers, and other healthcare stakeholders across multiple insurance lines.
