Physician Reviewer: Physical Medicine & Rehabilitation Job at Dane Street, LLC, West Palm Beach, FL

bUIyZWg0MVl6eVdOSG1QSGEyUG5DZHNad3c9PQ==
  • 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.

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,

Similar Jobs

Choice Products

Box Truck Delivery Driver - Seasonal (Temp) Job at Choice Products

 ...Fundraising deliveries are starting soon and we are hiring for our driver positions. APPLY TO THIS AD TODAY OR CALL (***) ***-****...  ...FOR JILL. What we need from you is: Ability to Drive a Straight Box Truck with manual transmission. Air Brake Endorsement Required (... 

Nature's Herbs and Wellness / High Plainz Strains

Cultivator - Nature's of Garden City Job at Nature's Herbs and Wellness / High Plainz Strains

Come join the growing field of cannabis! We are searching for a full time Cultivator to join our team in Garden City! General Info: Candidates with a current badge to work in the cannabis industry in Colorado will be given heavy preference. If you do not have that...

Holiday Inn Express

Hotel Maintenance Technician Job at Holiday Inn Express

 ...Maintenance Technician Madison, OH Holiday Inn Express is currently seeking part- and full-time Hotel Maintenance Technicians in Madison, Ohio. What we can offer YOU: ~ Dental Insurance ~ Vision Insurance ~401(k)~ Life Insurance ~ Health insurance... 

UC Davis Health

Surgery Clinic RN Job at UC Davis Health

 ...priorities, and use abstract thought to evaluate clinical situations. Participates in patient and...  .... At least two (2) years of recent RN experience caring for surgical patients....  ...% - Research Department Overview Outpatient Surgery Clinic covering the Cypress... 

Eastern Oregon University

Assistant Professor Psychology (Tenure-Track Position) | Eastern Oregon University Job at Eastern Oregon University

 ...Eastern Oregon University's Psychology Program invites applications...  ...psychology prepares students for entry into graduate and...  ...prepares students for entry-level positions in the helping professions...  ...professional programs, including: 23 bachelor's degrees and partnership...