Physician Reviewer/Advisor For Independent Medical Exams (Ime)As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize 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 criteriaEnsures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decisionIdentifies, 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 sizesProvides copies of any criteria utilized in a review with the report promptlyReturns cases on or before the due date and timeMakes telephone calls as mandated by the state and/or client specificsMaintains proper credentialing, state licenses, and any special certifications or requirements necessary to perform the jobPerforms other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or auditsBoard certification required, active practice requiredPlease be aware that, in the interest of all parties, Dane Street won't conduct interviews via text or request checks from candidates for any reason, including the purchase of equipment.
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