This role focuses on remote utilization review for orthopedic surgery cases, with an emphasis on assessing the medical necessity of treatment requests and appeals using evidence-based criteria. The work is non-clinical and involves no patient contact, no treatment, and no doctor-patient relationship. Physicians also review workers’ compensation-related cases and provide written determinations within required timeframes.
Key Responsibilities
- Review medical records to assess the medical necessity of requested services and appeals
- Use state-specific workers’ compensation guidelines and nationally recognized review criteria
- Submit clear, concise, evidence-based determinations
- Complete reviews within required turnaround times
- Participate in peer-to-peer calls as needed
- Complete addenda when additional information is submitted
Required
- Board certification in Orthopedic Surgery
- Active, unrestricted Texas medical license
- Active clinical practice
Preferred
- Workers’ Compensation Board Certification
Benefits & Perks
- Fully remote work
- Independent contractor (1099) status
- Flexible scheduling and control over volume and availability
- Supplemental income with flat-rate per-case compensation
- Average case time of 15 minutes or less
- Pre-organized medical records provided
- User-friendly portal and streamlined case management
- Full onboarding and ongoing support