This role focuses on telework utilization review and appeal case reviews for treatment requests and previously denied services in neurological surgery. The physician provides independent, advisory-only medical necessity opinions on a case-by-case basis, with work that can be scheduled around an active practice.
Key Responsibilities
- Conduct medical necessity reviews for treatment requests and appealed denials in neurological surgery.
- Provide advisory-only determinations without establishing a doctor-patient relationship or delivering treatment.
- Review case files and supporting medical records through a web-based work portal.
- Use treatment guidelines and chronological record summaries to support clinical decision-making.
- Participate in peer-to-peer discussions when adverse determinations require provider contact.
- Coordinate with administrative support teams that prepare cases and manage communication.
- Complete reviews within assigned turnaround times based on scheduled availability.
Required
- Current, unrestricted Tennessee medical license.
- Board certification.
- Active clinical practice.
- Training or experience in neurological surgery.
Preferred
- Prior experience with utilization review or independent medical review.
- Comfort working in a telework or remote review model.
Benefits & Perks
- Independent contractor 1099 arrangement.
- Per-case compensation.
- Schedule flexibility with case volume based on availability.
- Telework setting.
- Streamlined case flow with administrative support.
- Initial training and ongoing support.
- Advisory-only work with no treatment responsibilities.