Dane Street is seeking experienced Orthopedic Surgeons to join our growing team of expert medical reviewers. In this role, you will apply your expertise to conduct comprehensive reviews of clinical cases and provide objective, evidence-based medical opinions. This is a telework opportunity that allows you to customize your schedule while working as a 1099 independent contractor. Your primary responsibilities will include reviewing medical records, preparing clear and concise clinical summaries, and responding to specific questions from our clients related to orthopedic care. Join a team that values your clinical judgment and commitment to improving the quality, accuracy, and consistency of healthcare assessments. Your expertise plays a vital role in supporting high-quality, defensible medical determinations.

Employment Type: Full timeShift: Day Shift Description: Why MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. Position Purpose The Coordinator, Utilization Management Intake performs duties to support the Utilization Management department including management of internal and external calls, managing/triaging all departmental authorization/referral requests and assisting in compliance-driven auditing and reporting. What You Will Do: - Assists with the management of departmental processes, auditing and reporting deliverables and initiatives in compliance with federal and state regulatory agencies. - Receives, interprets and responds to evaluation utilization review inquiries - · Manages incoming medical records, authorization requests and referrals for department. - · Manages department call tracking system and triage incoming calls as appropriate. - · Coordinates, oversees, records and transmits information pertinent utilization review processes. - · Assists with administrative responsibilities such as meeting preparation, minutes, mailings faxing/scanning department records, ordering of departmental supplies, etc. - · Responsible for performing a variety of tasks requiring independent judgement and initiative. - · Establishes and maintains effective working relationships with other departments. - · Establishes and maintains strong positive communication with key stakeholders. ​ Minimum Qualifications: - Education: High School required; Bachelor's degree preferred - · Experience: Minimum of two (2) years data entry experience, with healthcare field preferred. - · Effective Communication Skills - · Understanding of medical terminology required. - · Must have in-depth computer skills including word processing software (e.g. Microsoft - Office) and data entry. - · Ability to work independently with minimal supervision. - · Must be able to document data accurately into computer system, and maintain statistical - records and reports. - · Must possess a high degree of motivation, initiative and organizational ability. - · Familiarity with managed care and claims processing required, including CPT & ICD-10 - · coding, phone triaging, referrals and authorizations. - · Must be able to maintain confidentiality of work documents. - · Knowledge of managed care issues related to utilization management, plan benefits and provider contacts. - · Ability to work with physician offices in facilitating authorizations. ​ Position Highlights and Benefits: - Mount Carmel Health System recognized by Forbes in 2025 as one of America’s Best State Employers. - Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one. - Retirement savings account with employer match starting on day one. - Generous paid time off programs. - Employee recognition programs. - Tuition/professional development reimbursement starting on day one. - RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing. - Relocation assistance (geographic and position restrictions apply). - Employee Referral Rewards program. - Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day! - Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups. Ministry/Facility Information: Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You! We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

• Perform Medicare comprehensive medical record and claims review to make payment determinations for Medicare Durable Medical Equipment (DME). • Perform projects or duties as assigned as a Medical Review Specialist. • Conducts in-depth claims analysis utilizing ICD-10-CM, CPT-4, and HCPCS Level II coding principles. • Utilize electronic health information imaging and input medical review decisions by electronic database module. • Utilize internet and intranet sources for policy verification. • Utilize Microsoft Office suite and other software templates as associated source input for claims review. • Make clinical judgment decisions based on clinical experience when applicable. • Meeting quality and production standards.

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.