Provide telework-based utilization review and medical necessity opinions for neurological surgery cases, including initial treatment requests and appeals of previously denied services. Reviews are advisory-only, with no patient care or doctor-patient relationship, and the caseload can be matched to your schedule.
Key Responsibilities
- Conduct chart-based reviews to determine the medical necessity of neurological surgery treatment requests.
- Evaluate appeals of previously denied services and provide advisory determinations.
- Use treatment guidelines and organized medical records to support clinical decision-making.
- Participate in peer-to-peer calls when adverse determinations require provider discussion.
- Coordinate with case support staff and follow turnaround times for timely report completion.
- Document determinations through the online case portal and complete reviews independently.
Required
- Current, unrestricted Tennessee medical license.
- Board certification in Neurological Surgery.
- Active clinical practice.
- Experience in medical necessity review or related physician review work is implied by the role.
Preferred
- Prior utilization review or independent review organization experience.
- Prior telework or remote review experience.
- Ability to work cases on a flexible, per-case basis.
Benefits & Perks
- Telework arrangement with schedule flexibility.
- 1099 independent contractor structure with per-case compensation.
- Caseload can be customized to your availability.
- Initial training and onboarding are provided.
- Administrative support is provided, including record organization and case preparation.
- User-friendly portal with organized records and treatment guidelines.
- Ongoing point of contact for questions after onboarding.