Licensed Physician Reviewer, Multiple Specialties

🔥 5 minutes ago

🌶️ New Mexico – Remote

🌶️ New Mexico – Remote

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

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Dane Street

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

Dane Street is a national leader in Independent Medical Exams and Reviews, providing objective, compliant, and timely Independent Medical Examinations, Peer Reviews, and other medical reports. With a large network of over 16,000 physicians, the company offers its services across 25,000 locations and 100 specialties, including Workers' Compensation, Auto, Liability, and Disability claims. Dane Street supports Insurance Carriers, Third Party Administrators, Managed Care Organizations, and Federal/State entities with expert medical analyses, helping them make accurate determinations. The company is recognized for its quality, fast turnaround times, and efficient processes, earning accolades like the NCQA Accreditation in Utilization Management and the Great Place to Work certification.

📋 Description

• Utilizes clinical expertise, reviews insurance appeals, and prospective and retrospective claims • 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

🎯 Requirements

• Candidates must hold an active NM License