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Physician Reviewer
2 months ago
Job Title: Physician Reviewer
Job Summary:
Dane Street, LLC is seeking a highly skilled Physician Reviewer to join our team. As a Physician Reviewer, you will utilize your clinical expertise to review insurance appeals, prospective and retrospective claims, and provide an interpretation of the medical necessity of services provided by other healthcare professionals.
Key Responsibilities:
- Medical Record Review: Review all medical records and address each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria.
- Rationale and Documentation: Ensure that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision.
- Criteria Utilization: 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.
- Case Management: Provide copies of any criteria utilized in a review with the report prior to the due time of the case, and return cases on or before the due date and time.
- Communication: Make telephone calls as mandated by the state and/or client specifics.
- Credentialing and Licensing: Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
- Training and Development: Attend all required orientation and training, and perform other duties as assigned.
Requirements:
Preferred candidates will hold a NM, TX, MN, and/or NC License. Physician Specialties: Radiation Oncology, Cardiology, Rheumatology, Ophthalmology, Otolaryngology, OB/GYN, Hematology/Oncology
Notice: 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.
