As a Physician Reviewer/Advisor for Independent Medical Record Reviews, you will leverage your clinical expertise to review insurance appeals and evaluate prospective and retrospective claims. You will provide an objective, evidence-based interpretation of the medical necessity of services provided by other healthcare professionals, in compliance with client-specific policies, nationally recognized guidelines, and standards of care.
Major Duties and Responsibilities
- Review all medical records and address each question posed by the client using client-specific criteria or other nationally recognized evidence-based standards.
- Ensure that the rationale for each determination is clear, concise, and supported by adequate documentation.
- Identify, critique, and utilize current guidelines, state and national standards, and peer-reviewed literature to support objective decision-making. Avoid relying on small-sample studies such as case reports when forming conclusions.
- Provide copies of any criteria referenced in the review along with the report.
- Complete and return cases by the assigned due date and time.
- Make telephone calls to clients when required by state regulations or client-specific protocols.
- Maintain proper credentialing, state licenses, and any required certifications.
- Perform other assigned duties, including responding to quality assurance issues, regulatory inquiries, depositions, court appearances, or audits.
- Board certification and active practice required.
Please Note: For security purposes, Dane Street will never conduct interviews via text or request payment or checks from candidates for any reason, including equipment purchases.
Benefits
- Robust opportunity for supplemental income.
- Schedule flexibility – you choose your case volume and conduct reviews based on your availability.
- Remote work – no doctor/patient relationship established and no treatment provided; these are advisory-only opinions.
- Enhanced industry expertise in medical necessity and utilization review.
- Expanded credentials as an expert in Independent Medical Reviews and physician advisory services.
- Fully prepped cases, streamlined case flow, and transcription services provided at no cost.
- User-friendly work portal for efficient case management.
About Dane Street
We support all referral processes, prepare all medical records, provide transcription services when applicable, facilitate all client communications, and ensure the quality and timeliness of all reports and report delivery.
