医生评审员
Physician Reviewer
Dane Street是一家获得“最佳工作场所”认证的公司，正在寻找一名骨科脊柱外科医生、神经外科医生、神经科医生以及物理医学与康复科医生来处理使用率审查。有工伤赔偿经验者优先，但非必需。这份远程办公机会允许您在标准的周一至周五工作周期内自定义您的工作时间表和案件数量，同时保持客户规定的处理时限。我们的审查员以每案为单位进行结算，作为1099独立承包商。优先考虑持有加利福尼亚州、佐治亚州、佛罗里达州、伊利诺伊州、肯塔基州、路易斯安那州、内华达州或德克萨斯州执照的候选人。
职位概述：
利用临床专业知识，通过提供其他医疗专业人员提供的服务是否符合州法规和指南、全国公认的循证指南、客户特定要求、政策、程序、绩效标准和URAC指南的医学适当性解释，来审查工伤赔偿索赔。
主要职责和责任：
- 审查所有医疗记录，并利用州规定或其他全国公认的循证标准解决客户提出的问题
- 确保决定的理由清晰、简洁，并包含足够的支持文件以证明该决定
- 在截止日期和时间前返回案件
- 按照州和/或客户特定要求进行电话联系
- 保持适当的资质和州执照，以及完成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，包括识别并回应质量保证问题、投诉、监管问题、传讯、出庭或审计
- 识别、评估并利用当前的标准和资源，如国家、州和专业协会指南以及同行评审文献，以支持审查中的合理和客观决策及理由；避免使用病例研究、队列等进行决策，因为它们的样本量有限
- 在报告中及时提供任何用于审查的标准副本
请注意：为了保障双方的安全，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购买设备的费用。
最初发布
查看英文原文
Dane Street, a certified "Great Place to Work" company, is in search of a Board Certified Orthopaedic Spine Surgeon, Neurosurgeon, Neurologist, and Physical Medicine & Rehabilitation physician to process utilization reviews. Worker's Compensation experience is preferred but, not required. This telework opportunity provides the ability to customize your schedule and caseload within a standard Monday - Friday work week while maintaining client-mandated turnaround times. Our reviewers are compensated on a per-case basis as a 1099 independent contractor. Preferred candidates will hold a CA, GA, FL, IL, KY, LA, NV, or TX license.
JOB SUMMARY:
Utilizes clinical expertise, and reviews workers' compensation claims by providing an interpretation of the medical appropriateness of services provided by other healthcare professionals in compliance with state regulations and guidelines, nationally recognized evidence-based guidelines, client-specifics, policies, procedures, performance standards, and URAC guidelines.
MAJOR DUTIES AND RESPONSIBILITIES:
- Reviews all medical records and addresses each question posed by the client utilizing state-mandated 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
- 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
- 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
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