Physician Reviewer

Dane Street; United States; Remote; USD 100,000 - 150,000; Full time

Job summary

Dane Street is seeking a Board Certified Orthopaedic Spine Surgeon, Neurosurgeon, Neurologist, or Physical Medicine & Rehabilitation physician for utilization reviews. This telework role offers flexible scheduling while ensuring compliance with state regulations and client policies.

Qualifications

• Preferred candidates will hold a license in CA, GA, FL, IL, KY, LA, NV, or TX.

Responsibilities

• Review medical records and address client questions using evidence-based criteria.
• Ensure clear rationale with supporting documentation for decisions.
• Maintain proper credentialing, licenses, and certifications.

Skills

Utilization Review

Clinical Expertise

Education

Board Certified Orthopaedic Spine Surgeon

Board Certified Neurosurgeon

Board Certified Neurologist

Board Certified Physical Medicine & Rehabilitation Physician

Job description

Job Description: Utilization Review Physician

Dane Street, a certified "Great Place to Work," is seeking a Board Certified Orthopaedic Spine Surgeon, Neurosurgeon, Neurologist, or Physical Medicine & Rehabilitation physician to perform utilization reviews. Worker's Compensation experience is preferred but not required. This telework opportunity allows you to customize your schedule and caseload within a standard Monday - Friday work week while adhering to client-mandated turnaround times. Reviewers are compensated on a per-case basis as 1099 independent contractors.

Preferred candidates will hold a license in CA, GA, FL, IL, KY, LA, NV, or TX.

Job Summary

Utilize clinical expertise to review workers' compensation claims by interpreting the medical appropriateness of services provided by healthcare professionals, ensuring compliance with state regulations, evidence-based guidelines, client policies, and URAC standards.

Major Duties and Responsibilities

1. Review all medical records and address client questions using state-mandated or recognized evidence-based criteria.
2. Ensure clear, concise rationale with adequate supporting documentation for decisions.
3. Return cases on or before the due date.
4. Make mandated telephone calls as required by state or client specifics.
5. Maintain proper credentialing, licenses, and certifications.
6. Attend all required orientation and training sessions.
7. Perform additional duties such as responding to quality assurance issues, regulatory matters, depositions, court appearances, or audits.
8. Utilize current criteria and resources, including national, state, and professional guidelines, supporting objective decision-making.
9. Provide copies of utilized criteria with review reports in a timely manner.

Please Note: Dane Street will never conduct interviews via text or request checks for equipment purchases.

Additional Information

• Seniority Level: Entry level
• Employment Type: Contract
• Job Function: Healthcare Provider
• Industries: IT Services and IT Consulting