Orthopedic Surgery Physician Reviewer

4 weeks ago


Nevada, United States Dane Street Full time

This remote role provides the opportunity for flexible scheduling and allows for the customization of workload while adhering to client-imposed deadlines. Compensation is structured on a per-case basis for independent contractors.

Ideal candidates should hold a valid NV License.

POSITION SUMMARY

As a Clinical Reviewer, you will leverage your medical expertise to evaluate insurance appeals, as well as prospective and retrospective claims. Your responsibilities will include assessing the medical necessity of services rendered by other healthcare providers in line with client-specific policies and established protocols.

KEY RESPONSIBILITIES:

  • Examine medical documentation and respond to client inquiries based on established criteria
  • Deliver clear and well-supported rationale for decision-making with appropriate documentation
  • Employ current guidelines and resources to facilitate objective evaluations
  • Timely submit necessary criteria along with the review report
  • Comply with deadlines and conduct required phone communications
  • Maintain all necessary credentials, licenses, and certifications
  • Engage in training and orientation sessions as required
  • Address quality assurance concerns, complaints, and regulatory issues

Please note: Dane Street does not conduct interviews via text or require candidates to purchase equipment with personal funds for security purposes.



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