Review medical records and claims as an advisory physician for independent medical exams, insurance appeals, and prospective or retrospective utilization reviews. The work centers on determining medical necessity using client-specific criteria, nationally recognized evidence-based guidelines, and standards of care. Cases are handled without treatment or a doctor-patient relationship, with additional administrative and quality review responsibilities as needed.
Key Responsibilities
- Review medical records and answer client-specific questions using applicable criteria and evidence-based guidelines.
- Provide clear, concise rationales with supporting documentation for each determination.
- Use national, state, and professional association guidelines and peer-reviewed literature to support review decisions.
- Provide copies of any criteria used in the review with the report in a timely manner.
- Return completed cases by the assigned due date and time.
- Make telephone calls when required by state or client-specific requirements.
- Respond to quality assurance issues, complaints, regulatory issues, depositions, court appearances, and audits as assigned.
- Maintain required credentialing, state licenses, and any special certifications needed to perform the work.
Required
- Board certification.
- Active clinical practice.
- Current credentialing and state licenses required to perform the role.
- Ability to meet any special certifications or requirements needed for the assignment.
Preferred
- Experience with independent medical exams or physician advisor work.
- Familiarity with utilization review, medical necessity review, or insurance appeals.
Benefits & Perks
- Supplemental income opportunity.
- Schedule flexibility with predictable work hours.
- Ability to choose services, case types, and case volume based on availability.
- No treatment responsibilities and no doctor-patient relationship.
- Prepped cases, streamlined case flow, and a user-friendly work portal.
- Transcription services provided at no cost, as applicable.
- Support with referrals, scheduling, case preparation, client communications, and report delivery.