This is a telework, independent contractor role for a physician who reviews medical records and provides advisory opinions on the medical necessity of proposed or rendered services, with a focus on neurological surgery cases. The work centers on applying client-specific criteria and evidence-based guidelines to determine appropriateness of care, supported by written rationales and reports.
Key Responsibilities
- Review medical records and respond to client-specific review questions using applicable criteria.
- Provide concise, well-supported determinations with clear rationale and documentation.
- Use national, state, and professional guidelines along with peer-reviewed literature to inform reviews.
- Prepare and submit reports and any referenced criteria in a timely manner.
- Complete required calls or call attempts based on state and client requirements.
- Maintain required credentialing, licenses, and certifications for the reviewer role.
- Attend required orientation and training.
- Identify and respond to quality assurance, complaint, and regulatory issues as assigned.
Required
- MD or DO degree.
- Nevada medical license.
- Clinical expertise in neurological surgery.
- Ability to perform utilization review or medical necessity review work.
- Ability to maintain required credentials, licenses, and any special certifications.
Preferred
- Experience with medical necessity review or utilization management.
- Experience providing physician advisor or independent review services.
Benefits & Perks
- Telework/remote work opportunity.
- Independent contractor 1099 arrangement.
- Per-case compensation.
- Flexible schedule with ability to choose case volume.
- Supplemental income opportunity.
- Support with case preparation, scheduling, transcription, and client communications.
- Streamlined case flow and a user-friendly work portal.