This role involves conducting utilization reviews of workers’ compensation claims, applying clinical expertise to determine the medical appropriateness of services provided by other clinicians. It is a telework, case-by-case review role with a focus on evidence-based decision-making, clear written rationale, and timely turnaround. The work is independent contractor based and may include required phone calls, quality review, and other review-related duties.
Key Responsibilities
- Review medical records and answer client questions using state-mandated or evidence-based criteria.
- Provide clear, concise rationales supported by appropriate documentation.
- Return cases by the required due date and time.
- Make telephone calls when required by state or client rules.
- Maintain active credentialing, licenses, and any required certifications.
- Attend required orientation and training.
- Identify and respond to quality assurance, regulatory, complaint, deposition, court, or audit issues as needed.
- Use current national, state, and professional guidelines and peer-reviewed literature to support objective review decisions.
Required
- Board certification in Orthopaedic Spine Surgery, Neurosurgery, Neurology, or Physical Medicine & Rehabilitation.
- Active physician licensure as required to perform utilization review work.
- Ability to review workers’ compensation cases and provide medical necessity determinations.
Preferred
- Workers’ compensation experience.
- Active medical license in CA, GA, FL, IL, KY, LA, NV, or TX.
Benefits & Perks
- Telework opportunity.
- Ability to customize schedule and caseload within a standard Monday through Friday workweek.
- Per-case compensation as a 1099 independent contractor.
- Great Place to Work certified employer.