Dane Street

National physician-based IME and peer reviews

Orthopedic Surgery Spine Surgeon

Physicians & SurgeonsConfirmed live in the last 24 hours

Full-timeNevada, USANo salary listedRemote

About the Job

Requirements

Preferred candidates will hold a Nevada license.
Maintain proper credentialing, state licenses, and any special certifications or requirements necessary to perform the job.

Responsibilities

Review insurance appeals and prospective and retrospective claims using clinical expertise.
Interpret 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.
Review all medical records and address each question posed by the client using client-specific criteria or other nationally recognized evidence-based criteria.
Ensure the rationale for each determination is clear, concise, and supported by adequate documentation.
Identify, critique, and use current criteria and resources, including national, state, and professional association guidelines and peer-reviewed literature, to support sound and objective review decisions and rationales; do not use case studies or cohorts to make decisions because of their limited sample sizes.
Provide copies of criteria used in a review with the report in a timely manner.
Return cases on or before the due date and time.
Make telephone calls as required by state or client-specific requirements.
Attend required orientation and training.
Perform other assigned duties, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.

Orthopedic Surgery - Spine Surgeon - NV

Dane Street, LLC · United States (Remote) · Contract · Posted 2024-02-19

Workplace: remote

Description

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.

Preferred candidates will hold a NV License.

JOB SUMMARY

Utilizes clinical expertise, and reviews insurance appeals, prospective and retrospective claims. The Physician Reviewer 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.

MAJOR DUTIES AND RESPONSIBILITIES:

Reviews all medical records and addresses each question posed by the client utilizing client-specific criteria 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
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
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

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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About the Company

Dane Street

National physician-based IME and peer reviews

Dane Street provides independent medical exams (IMEs) and peer-review services on a nationwide scale. It works with a panel of board-certified physicians located in all 50 states to deliver evaluations across Workers Compensation, Pharmacy, Disability, Group Health, and Auto/Liability cases. The process involves a physician-based review and evaluation system that produces expert reports with faster turnaround times, higher report quality, and increased satisfaction and productivity among adjusters and nurses. The company differentiates itself with its large, nationwide network and its focus on timely, high-quality evaluations across multiple lines of business. Its goal is to improve the accuracy and efficiency of medical reviews to support better decision-making for insurers, employers, and patients.

Company size: 201-500
Company stage: Not listed
Total funding: Not listed
Headquarters: Palm Beach Gardens, FL
Founded: 2008

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