Match working

Physician Reviewer (Oncologist, Radiologist, Geneticist)

72% Flex
Full Remote
Full time
  • Remote from:United States

Physician Reviewer (Oncologist, Radiologist, Geneticist)

72% Flex
Remote: Full Remote
Contract: Full time
Work from: United States

Offer summary

Key responsabilities:

  • Utilize clinical expertise to review insurance appeals and claims
  • Provide clear and concise medical necessity interpretations based on guidelines
Dane Street, LLC logo
Match working
Dane Street, LLC
InsuranceSME

http://www.danestreet.com

51 - 200 Employees

Job description

Logo JobgetherYour missions

Dane Street, a certified "Great Place to Work" company, is in search of a Board Certified Oncologist, Interventional Radiologist, Pediatric Oncologist, Radiation Oncologist, Hematologist/Oncologist, and Medical Geneticist, physician to process Utilization Reviews / Group Health Appeals Reviews. 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 TX license. Other preferred licenses are MN, IL, and CA.


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.



See more

Required profile

Match working
Experience
Industry :
Spoken language(s)
Check out the description to know which languages are mandatory.
Match working
Hard Skills
Soft Skills
  • Maintain proper credentials and required licenses
  • Communicate effectively and professional with clients and stakeholders

Go Premium: Access the World's Largest Selection of Remote Jobs!

  • Largest Inventory: Dive into the world's largest remote job inventory. More than half of these opportunities can't be found on standard platforms.
  • Personalized Matches: Our AI-driven algorithms ensure you find job listings perfectly matched to your skills and preferences.
  • Application fast-lane: Discover positions where you rank in the TOP 5% of applicants, and get personally introduced to recruiters with Jobgether.
  • Try out our Premium Benefits with a 7-Day FREE TRIAL.
    No obligations. Cancel anytime.

Find other similar jobs

🚀 Go Premium
Access the World's Largest Selection of Remote Jobs!

🚀

Go Premium
Access the World's Largest Selection of Remote Jobs!

Start Your Free TrialDon’t ask again