This role focuses on in-person physician review and advisory work for insurance appeals, prospective and retrospective claims, and medical necessity determinations. The work is advisory-only, with no patient treatment or doctor-patient relationship established, and cases are customized to your availability.
The physician reviews medical records, applies evidence-based and client-specific criteria, and may complete telephone calls when required by the state or client. Support is provided for case preparation, record handling, transcription, scheduling, client communications, and report delivery.
Key Responsibilities
- Review medical records and answer client-specific review questions using established criteria
- Provide clear, concise rationale with supporting documentation for each determination
- Use nationally recognized evidence-based guidelines, state guidelines, and professional literature to support decisions
- Return completed cases by the required due date and time
- Make telephone calls when required by state or client guidelines
- Maintain active credentialing, state licensure, and any required special certifications
- Attend required orientation and training
- Respond to quality assurance issues, complaints, audits, regulatory issues, depositions, or court appearances as assigned
Required
- MD or DO degree
- Board certification in Internal Medicine, Family Medicine, or Occupational Medicine
- Active medical practice
- Active state medical license
- Ability to perform in-person case reviews
Preferred
- Experience with insurance appeals, utilization review, or medical necessity reviews
- Experience with independent medical exams or physician advisor work
- Experience in Delaware or with multi-state licensure requirements
Benefits & Perks
- Independent 1099 contractor arrangement
- Per-case compensation
- Flexible schedule with case volume chosen by the physician
- Supplemental income opportunity
- Fully prepared cases and streamlined case flow
- Transcription services at no cost
- User-friendly work portal
- Support with scheduling, records preparation, client communications, and report delivery