Orthopedic Surgery - Spine Surgeon - NV

Dane Street; United States; Remote; USD 30,000 - 60,000; Part time

Job summary

Dane Street is seeking a Physician Reviewer to work remotely as an independent contractor in the United States. You will apply clinical expertise to review insurance appeals and determine medical necessity in line with client policies and guidelines.

This role offers flexible scheduling and caseload management, with client-mandated turnaround times. You will maintain credentials and participate in orientation while delivering timely, well-documented decisions.

Qualifications

• Reviews medical records and answers client questions using criteria and standards.
• Ensures rationale is clear with documentation to substantiate the decision.
• Keeps current criteria resources and uses evidence-based guidelines.

Responsibilities

• Reviews all medical records and addresses client questions using client-specific criteria.
• Ensures that the rationale for the determination is clear and documented with adequate supporting materials.
• Identifies and utilizes current national/state guidelines and peer-reviewed literature to support decisions.
• Provides copies of criteria used in reviews with the report in a timely manner.
• Returns cases on or before the due date and time.
• Makes telephone calls as mandated by state and client specifics.
• Maintains credentialing and state licenses and any necessary certifications.
• Attends required orientation and training.
• Performs other duties including QA issues, complaints, regulatory issues, deposits, or audits.

Job description

This telework 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 NV License.

JOB SUMMARY

Utilizes clinical expertise, and reviews insurance appeals, 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.