Provide utilization reviews for orthopedic spine surgery cases by evaluating medical records, treatment requests, and appeals to determine medical necessity. This fully remote, non-clinical role focuses on evidence-based determinations rather than direct patient care, with opportunities to review workers’ compensation cases and participate in peer-to-peer discussions when needed. Work is flexible and case volume is self-directed, with support from a streamlined review portal and organized records.
Key Responsibilities
- Review medical records to assess the medical necessity of requested services
- Apply state-specific workers’ compensation guidelines and nationally recognized criteria
- Submit clear, concise, evidence-based review determinations
- Complete reviews within required turnaround times
- Participate in peer-to-peer calls as needed
- Complete addenda when additional information is received
Required
- Board certification in Orthopedic Surgery
- Active, unrestricted New York medical license
- New York Workers’ Compensation Board certification
- Active clinical practice
Preferred
- Spine surgery focus
Benefits & Perks
- Fully remote work
- Independent contractor (1099) status
- Flexible scheduling with self-directed volume and availability
- Supplemental income with flat-rate per-case payment
- Chronological, pre-organized medical records provided
- User-friendly portal and streamlined case management
- Full onboarding and ongoing support