This role focuses on telework utilization review for general surgery, where the physician reviews treatment requests and appeals to determine medical necessity. Work is advisory only, with no patient care or treatment provided, and cases can be completed on a flexible schedule around an active practice.
Key Responsibilities
- Review treatment requests for medical necessity in general surgery cases.
- Provide appeal reviews for previously denied services.
- Render advisory-only clinical determinations without establishing a doctor-patient relationship.
- Use an online work portal to review organized medical records and treatment guidelines.
- Participate in peer-to-peer calls when adverse determinations require them.
- Complete cases according to assigned turnaround times and document determinations/reports.
Required
- Current, unrestricted Colorado medical license.
- Board certification.
- Active clinical practice.
- General surgery specialty.
Benefits & Perks
- Telework arrangement with schedule flexibility.
- Independent contractor 1099 role with per-case compensation.
- Ability to choose services, case types, and review volume based on availability.
- Training and onboarding completed in less than one week.
- Streamlined case flow with administrative support and organized medical records.
- User-friendly portal with easy access to records and treatment guidelines.
- Peer coordinators help secure provider availability for peer-to-peer calls.
- Ongoing point of contact for questions about completing reviews.