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Dane Street · 5 months ago

Board-Certified Internal Medicine Specialist for IME

Moxee, WA

Contract

Onsite

Senior Level

Dane Street is a company that specializes in Independent Medical Exams (IME), and they are seeking a Board-Certified Internal Medicine Specialist to act as a Physician Reviewer/Advisor. The role involves reviewing medical records, ensuring compliance with guidelines, and providing advisory opinions on medical necessity for insurance claims.

Auto InsuranceCommercial InsuranceEmployee BenefitsFinancial ServicesHealth InsuranceInsurance

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

Qualification

Board certificationClinical expertiseMedical necessity reviewUtilization reviewQuality assuranceCommunication skills

Required

Board certification required

Active practice required

Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job

Utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims

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

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

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

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

Benefits

Robust opportunity for supplemental income

Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability

No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions

Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise

Expanded credentials as an expert in Independent Medical Exams and physician advisor services

Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal