新墨西哥州认证医师评审员（医学博士、骨科博士）- 多个专业
New Mexico-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties
这份远程工作机会允许你在一周内自定义你的日程和案件数量，同时遵守客户规定的处理时间。我们的评审人员按件计酬，作为1099独立承包商获得报酬。
候选人必须持有有效的NM执照。
医生专科：内分泌学、胃肠病学、皮肤病学、神经学、精神病学、风湿病学、儿科、眼科。
职位概述
利用临床专业知识，审查保险上诉以及前瞻性与回顾性索赔。医生评审人员将根据客户特定政策、全国公认的循证指南和护理标准，对其他医疗专业人员提供的服务的医疗必要性进行解释。
主要职责和责任：
- 审查所有医疗记录，并根据客户特定的标准或其他全国公认的循证标准来解决客户提出的问题
- 确保决定的理由清晰、简洁，并包含足够的支持性文件以证明该决定
- 识别、评估并使用当前的标准和资源，如国家、州和专业协会的指南以及同行评审文献，以在评审中做出合理且客观的决策和理由；由于样本量有限，不得使用案例研究、队列等进行决策
- 在报告中及时提供任何用于评审的标准
- 在截止日期或之前返回案件
- 根据州和/或客户的具体要求进行电话联系
- 保持适当的资质认证和州执照，以及完成执行工作所需的任何特殊认证或要求
- 参加所有必要的入职培训
- 执行其他指派的任务，包括识别和回应质量保证问题、投诉、监管问题、作证、出庭或审计
请注意：为保障双方的安全，请注意Dane Street永远不会通过短信进行面试或要求候选人支付费用购买设备。
最初发布于喜马拉雅山
查看英文原文
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.
Candidates must hold an active NM License.
Physician Specialties: Endocrinology, Gastroenterology, Dermatology, Neurology, Psychiatry, Rheumatology, Pediatrics, Ophthalmology.
JOB SUMMARY
Utilizes clinical expertise, 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 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.
Originally posted on Himalayas