Ophthalmology Physician

Dane Street; Philadelphia (Philadelphia County); On-site; USD 120,000 - 160,000; Full time

Job summary

A leading healthcare company seeks a Physician Reviewer for Independent Medical Exams in Philadelphia. This role involves reviewing medical records, ensuring compliance with evidence-based guidelines, and making objective decisions on medical necessity. Ideal candidates must be board certified and active in practice, contributing to quality assurance and regulatory compliance.

Qualifications

• Must have board certification and maintain active practice.
• Ability to utilize evidence-based guidelines for reviews.
• Effective communication for clear rationale in determinations.

Responsibilities

• Review medical records and provide interpretations of medical necessity.
• Ensure clear rationale and supporting documentation for decisions.
• Maintain proper credentialing and comply with client-specific criteria.

Skills

Clinical expertise

Analytical skills

Attention to detail

Education

Board certification

Active medical practice

Job description

As Physician Reviewer / Advisor for Independent Medical Exams (IME), you will utilize 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

Board certification required, active practice required

PLEASE BE AWARE : In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment.

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Physician Ophthalmology • Philadelphia, PA, United States