New Mexico-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties

Dane Street, LLC; New Mexico; Remote; USD 137,760 - 206,640; Part time

Job summary

A healthcare review company is seeking a Physician Reviewer to work telecommuting. This role utilizes clinical expertise to review insurance appeals and claims. Candidates must possess an active NM License and have a solid understanding of evidence-based guidelines. Responsibilities include reviewing medical records, ensuring documentation quality, and maintaining licensure. This role offers a custom schedule as a 1099 independent contractor.

Qualifications

• Must hold an active NM License.
• Familiarity with evidence-based guidelines.
• Ability to critique and utilize current medical criteria.

Responsibilities

• Review medical records and address client questions.
• Ensure clear and concise rationale for decisions.
• Identify and utilize professional guidelines and literature.
• Return cases before the due date.
• Maintain proper credentialing and licenses.
• Attend required orientation and training.

Skills

Clinical expertise

Ability to interpret medical necessity

Strong documentation skills

Education

Active NM License

Job description

This telework opportunity allows you 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.

Candidates must hold an active NM License.

Physician Specialties: Endocrinology, Gastroenterology, Dermatology, Neurology, Psychiatry, Rheumatology, Pediatrics, Ophthalmology.

JOB SUMMARY

Utilizes clinical expertise, 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.