Remote Physician Reviewer — Utilization & Claims Review

Dane Street; Washington (District of Columbia); Remote; USD 90,000 - 160,000; Part time

Job summary

A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday – Friday work week. Responsibilities include reviewing medical records, ensuring compliance with state regulations, and providing clear rationale for case decisions. Preferred candidates should have a license in specific states. Compensation is based on a per-case basis as a 1099 independent contractor.

Qualifications

• Preferred candidates will hold a license in CA, GA, FL, IL, KY, LA, NV, or TX.
• Experience in Work's Compensation is preferred but not required.

Responsibilities

• Reviews all medical records and addresses client questions using state-mandated criteria.
• Ensures clear rationale for determinations with adequate documentation.
• Maintains proper credentialing and state licenses as required.

Job description

A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday – Friday work week. Responsibilities include reviewing medical records, ensuring compliance with state regulations, and providing clear rationale for case decisions. Preferred candidates should have a license in specific states. Compensation is based on a per-case basis as a 1099 independent contractor.