This telework-based physician reviewer role focuses on independent medical exams and advisory-only utilization review for insurance appeals, prospective claims, and retrospective claims. The work centers on assessing medical necessity, reviewing records, and completing clear, evidence-based determinations for orthopedic surgery cases and other case types assigned to your panel. Cases are scheduled around your availability, and the role is structured as independent 1099 contract work with supplemental income potential.
Key Responsibilities
- Review medical records and answer client-specific questions using evidence-based criteria.
- Assess the medical necessity of services provided by other healthcare professionals.
- Prepare clear, concise rationales with supporting documentation for each determination.
- Use national, state, and professional guidelines, along with peer-reviewed literature, to support review decisions.
- Complete reports by the due date and provide cited criteria with the review when required.
- Make telephone calls when mandated by state or client requirements.
- Maintain active credentials, licenses, and any required special certifications.
- Participate in required orientation, training, and quality assurance-related follow-up as needed.
Required
- MD or DO degree.
- Active New York medical license.
- Board certification in Orthopedic Surgery.
- Active clinical practice.
- Experience completing Independent Medical Exams.
Preferred
- New York State Workers' Compensation certification.
- Based in Onondaga County.
Benefits & Perks
- 1099 independent contractor arrangement.
- Per-case compensation.
- Telework opportunity.
- Schedule flexibility with case volume chosen by the clinician.
- Supplemental income opportunity.
- No doctor-patient relationship and no treatment responsibilities.
- Prepped cases, medical record preparation, and transcription services at no cost.
- Streamlined case flow and a user-friendly work portal.