Provide telework-based medical necessity reviews for orthopedic spine surgery cases, including initial treatment requests and appeals of previously denied services. This role is advisory-only and does not establish a doctor-patient relationship or provide treatment. Cases are assigned on a per-case basis and can be completed around an active clinical practice.
Key Responsibilities
- Review medical records and treatment guidelines to determine medical necessity for spine surgery-related requests.
- Evaluate appeals involving previously denied services and adverse determinations.
- Complete independent, advisory-only opinions within assigned turnaround times.
- Participate in peer-to-peer calls when needed for adverse determinations.
- Use the provided work portal to access chronological medical records and case materials.
- Coordinate reviews within a customized, scheduled caseload and selected case volume.
Required
- Current, unrestricted Louisiana medical license.
- Board certification.
- Active clinical practice.
- Specialty training or experience in Orthopedic Surgery, specifically Spine Surgery.
Preferred
- Prior experience with utilization review or independent medical review.
- Familiarity with medical necessity determinations and appeals review.
- Experience with telework or remote physician consulting.
Benefits & Perks
- Telework opportunity with schedule flexibility and customizable case volume.
- Independent 1099 contract role with per-case compensation.
- Initial training and onboarding completed in less than one week.
- Ongoing support from a point of contact for review questions.
- Streamlined case flow with administrative support, record organization, and report delivery coordination.
- Access to a user-friendly portal with chronological records and treatment guidelines.
- Peer coordinators help secure provider availability for peer-to-peer calls when needed.