IME Physician Panelist, WA Labor & Industries (L&I), Neurologist

Dane Street; Bellevue (WA); Presencial; USD 80.000 - 100.000; A tiempo parcial

Ventajas ofrecidas por este puesto de trabajo

Compensation for reasonable travel expenses

Assistance with WA L&I certification

Descripción de la vacante

Dane Street seeks a Physician Reviewer in Bellevue, WA, to utilize clinical expertise in reviewing insurance appeals and claims. This role involves ensuring compliance with guidelines and providing clear rationales for medical necessity determinations. Candidates must hold a WA license and be certified or willing to obtain certification with the Washington State Department of Labor and Industries. Flexible scheduling and per-case compensation structure are offered.

Formación

• Must hold a WA license and be certified or willing to gain certification.
• Strong clinical skills in reviewing medical records and claims.
• Ability to provide clear and concise rationales for decisions.

Responsabilidades

• Review and analyze all medical records based on client's criteria.
• Ensure determinations are backed by adequate documentation.
• Identify and utilize proper criteria and resources for decision-making.
• Return cases before due dates and maintain proper credentialing.
• Attend required training and orientation sessions.

Conocimientos

Clinical expertise

Medical necessity interpretation

Knowledge of evidence-based guidelines

Attention to detail

Educación

WA license

Certification with Washington State Department of Labor and Industries

Descripción del empleo

This 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 WA license and be certified, or willing to become certified, with the Washington State Department of Labor and Industries (L&I).

Highlights

• In‑person Exams to be conducted in Bellevue, WA, with additional locations to be added in the future
• Multiple exams over the course of a day
• Dane Street will pay for reasonable travel expenses
• Dane Street will assist you in obtaining WA L&I certification
• Video recording of approximately 15% of exams may be needed

Job Summary

Utilizes 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

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.