Family Practice - Without OB Physician

Dane Street; Saint Augustine (FL); Remote; USD 80,000 - 120,000; Full time

Job summary

Join a forward-thinking company as a Physician Reviewer/Advisor for Independent Medical Exams. In this role, you will leverage your clinical expertise to review insurance appeals and claims, ensuring compliance with established guidelines and standards of care. Enjoy the flexibility of choosing your services and case types while enhancing your industry knowledge in medical necessity and utilization review. This position offers a robust opportunity for supplemental income and supports your growth as an expert in IMEs and physician advisory services. Make a meaningful impact in the healthcare sector while maintaining a balanced schedule.

Benefits

Flexible schedule

Supplemental income opportunities

User-friendly portal

Transcription services at no cost

Qualifications

• Board certification and active practice required.
• Expertise in medical necessity and utilization review.

Responsibilities

• Review medical records and address client questions using evidence-based criteria.
• Ensure clarity and support for each determination with adequate documentation.

Skills

Clinical expertise in medical necessity

Knowledge of evidence-based guidelines

Ability to review medical records

Strong communication skills

Education

Board certification

Job description

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise to review insurance appeals and claims, both prospective and retrospective. The Physician Reviewer 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 other nationally recognized evidence-based criteria.
2. Ensure that the rationale for each determination is clear, concise, and supported by adequate documentation.
3. Identify, critique, and utilize current criteria and resources such as national, state, and professional guidelines, as well as peer-reviewed literature, avoiding limited-sample case studies or cohorts.
4. Provide copies of criteria used in reviews along with reports in a timely manner.
5. Complete case reviews on or before the specified due date and time.
6. Make mandated telephone calls according to state and/or client specifics.
7. Maintain proper credentialing, state licenses, and any required certifications.
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. Maintain board certification and active practice as required.

Please be aware: Dane Street will never conduct interviews via text nor request checks from candidates for any reason, including equipment purchases.

Benefits

• Robust opportunity for supplemental income
• Flexible schedule with predictable hours; you choose services, case types, and volume, conducting exams and reviews based on your availability
• No doctor/patient relationship or treatment is involved; these are advisory-only 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 referral processes, scheduling, case preparation, client communication, and ensures timely, quality report delivery.

Required and Preferred Qualifications

• Board certification and active practice required

Job Industries: Customer Service