This in-person, independent contract role involves reviewing insurance appeals and prospective and retrospective claims, with a focus on determining the medical necessity of services provided by other clinicians. Work is advisory only, with no treatment provided or doctor-patient relationship established. Physicians handle cases from their own schedule and may be asked to perform exams, reviews, and telephone discussions as required by the client or state.
Key Responsibilities
- Review medical records and address client questions using client-specific or evidence-based criteria.
- Provide clear, well-supported rationales for medical necessity determinations.
- Use current national, state, and professional guidelines and peer-reviewed literature to support review decisions.
- Return completed cases by the assigned due date and time.
- Make telephone calls when required by state or client-specific rules.
- Maintain active credentialing, state licensure, and any required special certifications.
- Attend required orientation and training.
- Respond to quality assurance, complaint, regulatory, deposition, court, or audit needs as assigned.
Required
- MD or DO degree.
- Board certification in Internal Medicine, Physical Medicine and Rehabilitation, Family Medicine, or Occupational Medicine.
- Active California medical license.
- Active clinical practice.
- Ability to provide in-person reviews in the Stockton area.
Preferred
- Experience with medical necessity review or utilization review.
- Experience with independent medical exams or physician advisor work.
- Familiarity with insurance appeals and claims review.
Benefits & Perks
- Independent contract, 1099 arrangement with per-case compensation.
- Schedule flexibility with case volume set by the physician.
- Supplemental income opportunity.
- No treatment responsibilities or doctor-patient relationship.
- Fully prepared cases and support with medical records, scheduling, and client communications.
- Transcription services at no cost.
- User-friendly work portal.
- Support for quality and timeliness of report delivery.