Physician Reviewer: Physical Medicine & Rehabilitation Job at Dane Street, LLC, West Palm Beach, FL

VDljSXJ2RUNjdU5IQU14ck9qKzRGQktBYlE9PQ==
  • Dane Street, LLC
  • West Palm Beach, FL

Job Description

Job Description

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.

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

For contractors,

Similar Jobs

Kelly Services

Registered Behavior Technician (RBT) Job at Kelly Services

 ...Job Description Pediatric Therapeutic Services (PTS) is currently seeking a passionate Registered Behavior Technician (RBT) to join our team, providing full-time school-based services for a local school district. \n\n Join us as we contribute to one of the most esteemed... 

Phoebe Putney Health System

Sterile Processing Operations Manager (Hiring Immediately) Job at Phoebe Putney Health System

 ...appropriate. Qualifications - External EDUCATION REQUIREMENTS ~ High School Diploma or GED (Required)~4 years / Bachelor's Degree in Nursing OR Bachelor of Science in the relevant healthcare field of study or 5 or more years of experience in a Perioperative... 

Solomon Page

Travel Pathology Assistant - $4,132 per week Job at Solomon Page

 ...Solomon Page is seeking a travel Pathology Assistant for a travel job in Cambridge, Massachusetts. Job Description & Requirements ~ Specialty: Pathology Assistant ~ Discipline: Allied Health Professional ~ Start Date: 03/10/2025~ Duration: 13 weeks ~40 hours... 

NIS EXPRESS

CDL A DRIVER -No Experience- Paid Training Job at NIS EXPRESS

 ...Now Hiring CDL-A Drivers Competitive Pay, Reliable Freight, and Strong Benefits Package...  ...Pay: $1,200$1,500 per week, based on experience Miles: 2,1002,300 per week Home...  ...with APUs ~ No slip seating take your truck home For Recent CDL-A Graduates:... 

Performance Foodservice

CDL Class A Shuttle Truck Driver - $94,000/year Job at Performance Foodservice

 ...and respect Position Purpose: Food and food service delivery Drivers fulfill a critical role in the countrys food supply chain. Our...  ...effective verbal and written communication skills Valid CDL A with Doubles Endorsement Must be 21 years of age Meet all...