放射诊断-医疗记录审核员
Diagnostic Radiology- Medical Record Reviewer
作为独立医疗检查（IME）的医师评审员/顾问，您将运用临床专业知识，审查保险申诉以及前瞻性与回顾性索赔。医师评审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学必要性进行解释。
主要职责和任务：
- 审查所有医疗记录并解决客户提出的所有问题，使用客户特定的标准或其他全国公认的循证标准
- 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、州和专业协会指南以及同行评审文献，以支持在评审中做出合理且客观的决策和理由；避免使用病例研究、队列等，因为它们的样本量有限
- 在报告中及时提供任何用于评审的标准
- 在截止日期和时间前返回案件
- 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、州执照以及执行工作所需的任何特殊认证或要求
- 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
- 需要行医执照，需有活跃执业
请注意，出于各方利益考虑，Dane Street不会通过文字消息进行面试，也不会以任何理由（包括购买设备）向候选人请求核查。
福利
- 丰厚的补充收入机会
- 时间安排灵活且工作时间可预测——您可选择服务类型和案件类型，自行决定工作量，并根据您的时间安排进行检查和评审
- 不建立医生与患者的关系，也不提供治疗。这些仅为咨询意见
- 增强行业专业知识，提升您的医疗实践，获得医学必要性和利用审查/管理方面的专业知识
- 扩展作为独立医疗检查和医师顾问服务专家的资质
- 全面准备好的案件，流程简化
查看英文原文
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 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 promptly
- 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, state licenses, and any special certifications or requirements necessary to perform the job
- Performs other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits
- Board certification required, active practice required
Please 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.
Benefits
Benefits
- Robust opportunity for supplemental income
- Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability
- No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions.
- Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise
- Expanded credentials as an expert in Independent Medical Exams and physician advisor services
- Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal
Originally posted on Himalayas