Physician Reviewer: Physical Medicine and Rehabilitation Specialist

4 days ago

West Palm Beach, Florida, United States Dane Street, LLC Full time

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:

As a Physician Reviewer with Dane Street, LLC, you will utilize your clinical expertise to review insurance appeals, prospective and retrospective claims. You 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.

Key Responsibilities:

  • Review all medical records and address each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria.
  • Ensure that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision.
  • Identify, critique, and utilize 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; refrain from using case studies, cohorts, and the like to make decisions due to their limited sample sizes.
  • Provide copies of any criteria utilized in a review with the report in a timely manner.
  • Return cases on or before the due date and time.
  • Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
  • Attend all required orientation and training.
  • Perform other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.

Important Note: In the interest of the security of both parties, please be aware that Dane Street, LLC will never conduct an interview via text or request checks from candidates for purchasing equipment.

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