Physician Reviewer: Neurological Surgery Job at Dane Street, LLC, West Palm Beach, FL

RU94b2IyY1RCWDBtVTdhbngyeFgvT0pr
  • Dane Street, LLC
  • West Palm Beach, FL

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 NY License, and be NY WC Board Certified.

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.

Job Tags

Contract work, For contractors,

Similar Jobs

Desire Home Care

Data Processing Clerk Job at Desire Home Care

 ...We are seeking a detail-oriented and organized Data Processing Clerk to join our Administrative team. This entry-level, full-time, hourly role is designed for individuals...  ...regarding data handling. No prior work experience required; however, previous experience in data... 

Maine Conservation Corps

Training Coordinator Job at Maine Conservation Corps

 ...December 27, 2024 ~40+ hours a week ~ Monday-Friday during training and orientation weeks ~ Flex schedule possible during the...  ...strengthen the future opportunities of members. The MCC Training Coordinator is responsible for creating, coordinating, and teaching a wide... 

Select Staffing

Customer Service Rep Job at Select Staffing

 ...Service RepresentativeBring Your Passion for Customer Service to Select.Looking for a company that values your experience and offers...  ...! Were part of Employbridge, the nations largest industrial staffing company with 30 years in business. Meaning we have hundreds of... 

Acloché

Warehouse and General Labor - Weekends off Job at Acloché

 ...work environment where your contributions are valued, and weekends off to enjoy your personal time. If you're looking for a role that combines physical...  ...Responsibilities Assist with the loading and unloading of parts and shipments. Organize and maintain inventory in... 

The Sheridan at Severna Park

Server (part time $15.00 per hour) Job at The Sheridan at Severna Park

Do you have HEART? We are looking for individuals who can embrace our mission to purposely brighten and enrich the lives of those we serve with HEART; Hospitality, Excellence, Appreciation, Respect & Teamwork. In this role you will provide quick, efficient and pleasant...