Offer summary

Qualifications:

Board Certified in Orthopaedic Spine Surgery, Neurosurgery, Neurology, or Physical Medicine & Rehabilitation., Experience in Worker's Compensation is preferred but not required., Possession of a valid medical license in CA, GA, FL, IL, KY, LA, NV, or TX., Ability to interpret medical appropriateness of services based on evidence-based guidelines..

Key responsabilities:

Review medical records and address client questions using state-mandated or nationally recognized criteria.

Ensure clear and concise rationale for determinations with adequate supporting documentation.

Return cases by the mandated due date and make necessary telephone calls as required.

Maintain proper credentialing, attend required training, and respond to quality assurance issues.

Job description

Dane Street, a certified "Great Place to Work" company, is in search of a Board Certified Orthopaedic Spine Surgeon, Neurosurgeon, Neurologist, and Physical Medicine & Rehabilitation physician to process utilization reviews. Worker's Compensation experience is preferred but, not required. This telework opportunity provides the ability to customize your schedule and caseload within a standard Monday - Friday work week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent contractor. Preferred candidates will hold a CA, GA, FL, IL, KY, LA, NV, or TX license.

JOB SUMMARY:
Utilizes clinical expertise, and reviews workers' compensation claims by providing an interpretation of the medical appropriateness of services provided by other healthcare professionals in compliance with state regulations and guidelines, nationally recognized evidence-based guidelines, client-specifics, policies, procedures, performance standards, and URAC guidelines.

MAJOR DUTIES AND RESPONSIBILITIES:

Reviews all medical records and addresses each question posed by the client utilizing state-mandated 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
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
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

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.

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