Provide telework-based utilization review for orthopedic spine cases, assessing the medical necessity of requested treatment and, on appeal, previously denied services. Work is advisory-only with no patient treatment or doctor-patient relationship, and case volume can be tailored to your availability.
Key Responsibilities
- Review medical records and supporting documentation to determine medical necessity for treatment requests.
- Evaluate appeals involving previously denied services.
- Issue advisory opinions based on clinical records and applicable treatment guidelines.
- Participate in peer-to-peer calls when needed for adverse determinations.
- Use a web-based portal to complete reviews and access organized case materials.
- Coordinate within a streamlined administrative workflow for timely report completion.
Required
- MD or DO degree.
- Active, unrestricted New York medical license.
- Workers Comp Board Certification.
- Board certification.
- Active clinical practice.
- Orthopedic surgery training with spine surgery focus.
Preferred
- Experience with utilization review or independent medical review.
- Experience completing case-based reviews in a telework setting.
Benefits & Perks
- Independent contractor 1099 arrangement.
- Per-case compensation.
- Schedule flexibility with case volume based on your availability.
- Initial training and onboarding in less than one week.
- Ongoing support from peer coordinators and a point of contact for questions.
- Streamlined case flow with organized records and treatment guidelines provided.
- Administrative tasks handled to keep focus on clinical decision-making.