Dane Street · 4 months ago
Board Certified-(M.D, D.O) California Pulmonology Advisor, Certified for IME
Daly City, California, United States
Full-time
Onsite
Senior LevelDane Street is seeking a Board Certified Physician Reviewer/Advisor for Independent Medical Exams (IME). The role involves utilizing clinical expertise to review insurance appeals and claims, ensuring compliance with evidence-based guidelines and client-specific policies.
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
Board certification required, active practice required
Qualification
Required
Board certification required
active practice required
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
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
Company
Dane Street
Dane Street is an insurance company that offers review and evaluation services for workers compensation, health, and to some businesses.
Founded in 2008
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Josh Remillard
Chief Operating Officer
Greg Powers
Chief Marketing Officer/SVP Sales
Recent News
EIN Presswire
2025-07-23
2025-05-23
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