Orthopedic Surgery - Spine Surgeon - NV
Read straight from Dane Street, LLC's careers page, verified 26m ago.Seekless can tailor your résumé to it.
Seekless can write your résumé for this posting first.
Before you apply
LocationNevada, United States
Work moderemote
Typecontract
Company size1,001–5,000 people
PostedFeb 19, 2024 · 2y ago
Verified live26m ago
May no longer be actively hiring
Posted by the company on Feb 19, 202474% of this company's open roles have been listed for 90+ days
At a glanceSummarised by Seekless from the posting.
Utilizes clinical expertise to review insurance appeals, prospective and retrospective claims
Review all medical records and address each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria
Ensure rationale for determination is clear, concise, and contains adequate supporting documentation
Identify, critique, and utilize current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature
Return cases on or before due date and time
Make telephone calls as mandated by the state and/or client specifics
Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
Attend all required orientation and training
Hold a NV License
Benefits
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.
Nice to have
Preferred candidates will hold a NV License.
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.