Dane Street, LLC logo
Dane Street, LLC

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Physician Reviewers - Hematology/Medical Oncology (Stem Cell Transplant )

Location

United States

Posted

90 days ago

Salary

0

Seniority

Mid Level

English

Job Description

Physician Reviewers - Hematology/Medical Oncology (Stem Cell Transplant )

Dane Street, LLC

This telework opportunity allows you 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 Physician Specialty: Hematology/Medical Oncology - Stem cell transplant specialists  JOB SUMMARY Utilizes clinical expertise, and reviews insurance appeals, and 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 on time - 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.

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United States
$89.2K - $151K / year
Job Closed
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$38 - $57 / hour
Job Closed