Certified General Surgeon for IME

Dane Street; Harrison (NJ); Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Physician Reviewer/Advisor for Independent Medical Exams. In this role, you will leverage your clinical expertise to review insurance appeals and claims, ensuring adherence to evidence-based guidelines and client-specific policies. Enjoy the flexibility of a contract position that allows you to choose your cases and work hours. This position offers an opportunity to enhance your industry expertise in medical necessity and utilization review, while also expanding your credentials as an expert in physician advisory services. Join a supportive team that streamlines case flow and provides necessary resources to succeed.

Benefits

Flexible schedule

Opportunity for supplemental income

User-friendly portal

Transcription services at no cost

Qualifications

• Utilize clinical expertise to review insurance appeals and claims.
• Ensure compliance with client-specific policies and standards of care.

Responsibilities

• Review medical records and address client questions using evidence-based criteria.
• Complete case reviews on or before the deadline.

Skills

Clinical expertise

Medical necessity interpretation

Evidence-based guidelines

Documentation skills

Education

Board certification

Active medical practice

Job description

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Requirements

As a Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise to review insurance appeals and prospective and retrospective claims. You will interpret the medical necessity of services provided by healthcare professionals, ensuring compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.

Major Duties and Responsibilities:

1. Review all medical records and address each question posed by the client using client-specific or nationally recognized evidence-based criteria.
2. Ensure that the rationale for decisions is clear, concise, and supported by adequate documentation.
3. Utilize current criteria and resources such as national, state, and professional guidelines, and peer-reviewed literature to support objective decision-making. Avoid using case studies or cohorts with limited sample sizes.
4. Provide copies of utilized criteria with the review report promptly.
5. Complete case reviews on or before the deadline.
6. Make mandated telephone calls based on state and client requirements.
7. Maintain proper credentialing, licenses, and certifications necessary for the role.
8. Attend all required orientation and training sessions.
9. Perform additional duties as assigned, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.
10. Board certification and active practice are required.

Note: Dane Street does not conduct interviews via text or request checks for equipment purchases to ensure security.

Benefits:

• Opportunity for supplemental income.
• Flexible schedule and predictable hours—choose your cases and work when it suits you.
• No doctor-patient relationship or treatment involved; these are advisory opinions.
• Enhance your industry expertise in medical necessity and utilization review/management.
• Expand credentials as an expert in IMEs and physician advisory services.
• Streamlined case flow, prepped cases, transcription services at no cost, and a user-friendly portal.

Dane Street supports all referral processes, case preparation, client communication, and report quality and timeliness.

Additional details:

• Seniority level: Mid-Senior level
• Employment type: Contract
• Job function: Healthcare Provider
• Industries: IT Services and IT Consulting