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As Physician Reviewer/Advisor for Disability Peer Review, you will utilize clinical expertise to review medical records provided and return an independent, professional opinion on the clamants functionality and restrictions or limitations as it relates to an application for disability benefits or the current status of disability.
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Evaluates Appeals case work by the application of closed case review standards and related specific attributes and procedures as defined by the Guideline. Independent Office of Appeals: Case & Operations Support/Policy Planning Quality & Analysis/AQMS.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal. Identifies and employs 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.
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Our physician panel is comprised of independent contract reviewers (1099) compensated on a per-case basis. Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability.
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Ensure cases are returned by the reviewer in a timely manner in order to meet case deadlines. 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.
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Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery.
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Experience conducting employment tax examinations (e.g., non-filers, 1120S officer compensation, worker classification, tip audits with multiple establishments, accountable plans, mergers & acquisitions, advanced executive compensation, advanced fringe benefits, and large case audits.
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We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process. An Associates Degree or Bachelors Degree is preferred.
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5 years of Case Management / Utilization Review experience, or a Foreign Medical Graduate. Working experience with electronic medical records, and/or discharge planning and case management systems.
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This is a telework opportunity for supplemental income for physicians providing a caseload customized to your schedule. On a contract basis as individual schedule permits, accepts cases, reviews all medical records, and addresses each question posed utilizing client-specific criteria or other nationally recognized evidence-based criteria and opines on disability status.
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Robust opportunity for supplemental income. Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise. Completes peer-to-peer calls/call attempts as required based on client-specific protocol with the goal of obtaining information not included in medical records as well as any necessary clarification.
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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.
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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.
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Determinations are based on the clinical evidence within the medical records provided. No doctor/patient relationship is established and no treatment is provided. Expanded credentials as an expert in Independent Medical Exams and physician advisor services.
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Performs other duties as assigned including addressing any necessary clarification, providing addendum as required (with additional compensation,) identifying and responding to potential quality assurance issues, complaints, and regulatory issues.
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case reviewer jobs
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