Board Certified Rheumatology Physician Advisor - Disability Peer Reviewer

D
United StatesContract
Salary not disclosed
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Job Details

Requirements

  • US Board certification required
  • Active practice preferred

Responsibilities

  • Accept cases, review all medical records, and address each question posed utilizing client-specific criteria or other nationally recognized evidence-based criteria, and opine on disability status
  • Ensure a clear rationale for the determination that is concise and contains adequate supporting documentation to substantiate the decision
  • Identify and employ 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; refrain from using case studies, cohorts, and the like to make decisions
  • Provide a report and copies of any criteria utilized within the review promptly
  • Return cases on or before the due date and time specified
  • Complete 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
  • Perform 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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