Otolaryngology Physician

Dane Street; Dover (DE); Remote; USD 80,000 - 120,000; Part time

Job summary

A leading medical review firm seeks a Physician Reviewer/Advisor for Independent Medical Exams in Delaware. This role offers flexible scheduling and the opportunity to provide advisory opinions based on comprehensive medical reviews without establishing a doctor-patient relationship. Candidates must have board certification and an active medical practice. Join us to enhance your expertise in medical necessity and utilization review.

Benefits

Flexible schedule

Supplemental income opportunity

Transcription services at no cost

Qualifications

• Board certification required and active medical practice necessary.
• Maintains proper credentialing and state licenses.
• Must comply with client and regulatory requirements for medical necessity.

Responsibilities

• Review all medical records based on client-specific criteria.
• Ensure clear rationale for all decisions with adequate documentation.
• Identify and utilize current medical criteria and guidelines.

Skills

Clinical expertise

Attention to detail

Document thoroughness

Knowledge of medical necessity guidelines

Regulatory compliance awareness

Education

Board certification

Active medical practice

Job description

Overview

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; 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
• 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

Qualifications

• Board certification required, active practice required
• Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
• Be aware of and comply with client and regulatory requirements as applicable to medical necessity and utilization review

Benefits/Working Arrangements

• 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.

Note: This posting does not solicit for any form of payment or advance fee; be cautious of offers that require payment or ask for sensitive information outside of standard application processes.