This role focuses on reviewing orthopedic spine surgery cases for medical necessity, with physicians providing evidence-based utilization review opinions on treatment requests and appeals. It is a fully remote, non-clinical contractor role with no patient contact or treatment, and the work is completed through a streamlined case review process.
Key Responsibilities
- Review medical records to determine the medical necessity of requested services
- Apply state-specific workers’ compensation guidelines and nationally recognized criteria
- Submit clear, concise, and well-supported review determinations
- Complete reviews within required turnaround times
- Participate in peer-to-peer calls when needed
- Complete addenda when additional information is received
Required
- Board certification in Orthopedic Surgery
- Spine specialty focus preferred or relevant orthopedic spine expertise
- Active, unrestricted New York medical license
- New York Workers’ Compensation Board Certification
- Active clinical practice
Preferred
- Spine-focused orthopedic practice experience
- Prior utilization review or independent medical review experience
Benefits & Perks
- Fully remote work arrangement
- Independent contractor (1099) status
- Flexible scheduling with control over volume and availability
- Flat rate per case for supplemental income
- Pre-organized medical records and a user-friendly portal
- Onboarding and ongoing support provided