Board Certified-(M.D, D.O) Oklahoma Immunology Advisor, Certified for IME

Dane Street; Kingfisher (OK); On-site; USD 96,000 - 165,000; Full time

Benefits offered by this job

Supplemental income

Schedule flexibility

No doctor/patient relationship

Enhanced industry expertise

Expanded credentials as IME expert

Prepped cases / transcription services

Job summary

Dane Street is seeking a Physician Reviewer/Advisor for Independent Medical Exams to apply clinical expertise, review insurance appeals, and evaluate prospective and retrospective claims. The role requires board certification and active practice, plus credentialing and licensure maintenance.

You will interpret medical necessity in line with client policies and evidence-based guidelines, delivering concise, well-supported determinations.

Qualifications

• Board certification required and active practice.
• Ability to review records using client criteria and guidelines.
• Maintain credentialing and state licenses as required.

Responsibilities

• Review medical records and address client questions using criteria.
• Provide clear, concise rationale with supporting documentation.
• Utilize current guidelines and literature to support decisions.
• Return cases by due date and time.
• Make mandated telephone calls as required by clients.
• Attend orientation and training and perform QA as needed.
• Adhere to regulatory requirements and conduct audits when applicable.

Skills

Clinical judgment

Medical expertise

Evidence-based guidelines

Policy compliance

Education

Board certification

Job description

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and 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
• Board certification required, active practice required

Benefits

• Robust opportunity for supplemental income
• Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability
• No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions
• Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise
• Expanded credentials as an expert in Independent Medical Exams and physician advisor services
• Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal