Board-Certified Ophthalmologist for IME

Dane Street, LLC; Philadelphia (Philadelphia County); Remote; USD 80,000 - 150,000; Full time

Job summary

An established industry player is seeking a Physician Reviewer/Advisor for Independent Medical Exams (IME). In this dynamic role, you will leverage your clinical expertise to review insurance appeals and claims, ensuring compliance with client-specific policies and nationally recognized guidelines. Enjoy the flexibility of choosing your services and case types, allowing you to dictate your workload based on your availability. This position offers a robust opportunity for supplemental income while enhancing your credentials as an expert in medical necessity and utilization review. Join a supportive environment that prioritizes quality and efficiency in medical reviews.

Benefits

Schedule flexibility

Predictable work hours

Supplemental income opportunity

Transcription services at no cost

User-friendly work portal

Qualifications

• Board certification and active practice required for the role.
• Strong clinical expertise in reviewing insurance appeals and claims.

Responsibilities

• Review medical records and provide interpretations based on client criteria.
• Ensure clear rationale for decisions with supporting documentation.
• Maintain proper credentialing and state licenses.

Skills

Clinical expertise

Medical necessity interpretation

Evidence-based guidelines

Quality assurance

Communication skills

Education

Board certification

Active medical practice

Job description

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and review insurance appeals, as well as 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, 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.

PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment.

• 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.

Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery.