Ophthalmology- Independent Medical Examiner (IME)

Dane Street, LLC; Town of East Hampton (NY); Remote; USD 60,000 - 80,000; Part time

Job summary

A leading medical review firm is seeking a Physician Reviewer to evaluate insurance appeals and claims. This role offers flexible scheduling, with a focus on advisory opinions rather than treatment. Ideal candidates will be board certified and actively practicing, with expertise in medical necessity and utilization review. Additional benefits include robust supplemental income and a user-friendly work portal.

Benefits

Robust opportunity for supplemental income

Schedule flexibility and predictable work hours

User-friendly work portal

Qualifications

• Board certification required, active practice required.
• Ability to critique and utilize current criteria and resources.

Responsibilities

• Review all medical records and address client questions with utilized criteria.
• Provide clear and concise rationale for determinations.
• Maintain proper credentialing and state licenses.

Skills

Clinical expertise

Interpretation of medical necessity

Knowledge of evidence-based guidelines

Attention to detail

Time management

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, 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.

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
• 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
• Board certification required, active practice required

Benefits

• 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.

Please note that Dane Street will never conduct interviews via text or request checks from candidates for any reason, including the purchase of equipment.