Board Certified Physician Reviewer - Orthopedic Spine Surgery

Dane StreetHealthcare

United StatesContract

Salary not disclosed

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Job Details

Requirements

Current, unrestricted Texas Medical License.
Active clinical practice.
Board Certified in Orthopedic Surgery (Spine).
Ability to perform clinical decision-making reviews.
Must be able to work as an independent consultant (1099).
Availability to complete reviews within designated turnaround times (1-5 business days).

Responsibilities

Evaluate the medical necessity of treatment requests.
Review cases for appeals involving previously denied services.
Make clinical determinations based on provided medical records and treatment guidelines.
Participate in peer-to-peer calls for adverse determinations as necessary.
Utilize the designated work portal to manage and submit clinical reviews.
Maintain high quality and timely delivery of clinical determinations.

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