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

NXQ5WEJHenR6b1F6K3dwR24zQStDZTk1VEE9PQ==
  • 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

TRU Staffing, Inc.

eDiscovery Forensics Data Analyst Job at TRU Staffing, Inc.

Our client, a leading provider in digital forensics and eDiscovery services, is seeking an eDiscovery Forensics Data Analyst to lead forensic investigations and ensure the accurate handling, collection, and analysis of digital evidence. This role involves managing device... 

GDIT

Data Architect Expert Job at GDIT

 ...experience US Citizenship Required: Yes Job Description: Data Architect - Expert Transform technology into opportunity as a...  ...databases. Performs data access analysis design, and archive/recovery design and implementation. Develops strategies for data... 

Job Corps - Pittsburgh

Security Guard Job at Job Corps - Pittsburgh

 ...- Protecting and Serving Our Future Company Overview: Make a profound impact in the lives of at-risk youth with Job Corps, a government-funded, no-cost education and vocational training program under the U.S. Department of Labor. We help socioeconomically disadvantaged... 

Contour Airlines

Director of flight standards Job at Contour Airlines

 ...implements Flight Operations initiatives Execute safety risk management and perform safety assurance following Safety Management...  ...and leadership skills. Ability to manage multiple complex projects simultaneously. Excellent communication skills: both written... 

ABM

Journeyman Plumber Job at ABM

 ...needed for work on plumbing and other water conveyance systems. Carries out lead responsibilities if assigned in accordance with the ABMs policies and applicable laws. Responsibilities include service and repairs of plumbing systems; planning and carrying out hands...