Dane Street
Physician Reviewer - (Radiation Oncology, Cardiology, Rheumatology)
Dane Street, Dallas, Texas, United States, 75215
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 NM, TX, MN, and/or NC License. Physician Specialties: Radiation Oncology, Cardiology, Rheumatology, Ophthalmology, Otolaryngology, OB/GYN, Hematology/Oncology.
Job Summary Utilizes clinical expertise and reviews insurance appeals, as well as 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 prior to the due time of the case
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
Notice:
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.
Details
Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industries: IT Services and IT Consulting
Referrals increase your chances of interviewing at Dane Street by 2x.
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Dallas, TX .
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Job Summary Utilizes clinical expertise and reviews insurance appeals, as well as 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 prior to the due time of the case
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
Notice:
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.
Details
Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industries: IT Services and IT Consulting
Referrals increase your chances of interviewing at Dane Street by 2x.
Get notified about new Medical Doctor jobs in
Dallas, TX .
Other opportunities
Remote - Neurology for Utilization Review - contract 1099
PRN - Remote Utilization Review for Infectious Disease
Remote 1099 Work for Internal Medicine Physicians
Physician Reviewer - Texas Counter Affidavit Work (Orthopedic Surgery)
FULLY Remote teleNeurology Opportunities – Nationwide
1099 Utilization Review work for Family Medicine Doctor
Remote Telemedicine Physician – Men\'s Hormone Specialist (MD/DO)
Internal Medicine (Hospitalist) - Hospital at Home Staff Physician
Remote - Otolaryngology/ENT for Utilization Review - contract 1099
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Richardson, TX $187,700.00-$348,600.00 2 weeks ago
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Pathologist / Gross Pathology Image Contributor
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Dallas, TX $10,000.00-$450,000.00 10 months ago
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