In this remote, non-clinical role, the physician reviews orthopedic treatment requests and appeals to determine medical necessity using evidence-based criteria and workers’ compensation guidelines. The work centers on chart review rather than patient care, with occasional peer-to-peer calls and addenda when new information is submitted. It is structured as supplemental 1099 work with flexible case volume and onboarding support.
Key Responsibilities
- Review medical records to determine the medical necessity of requested services
- Use state-specific workers’ compensation guidelines and nationally recognized criteria
- Submit clear, concise, and well-supported utilization review determinations
- Complete reviews within required timeframes and respond to new information with addenda
- Participate in peer-to-peer calls as needed
- Work through a user-friendly portal with pre-organized medical records
- Manage case volume and availability independently
Required
- Board certification in Orthopedic Surgery
- Active, unrestricted New York medical license
- New York Workers’ Compensation Board Certification
- Active clinical practice
Preferred
- Experience with utilization review or independent medical review
- Familiarity with workers’ compensation guidelines
Benefits & Perks
- Fully remote work
- Independent contractor (1099) status
- Flexible scheduling and control over case volume
- Flat rate per case for supplemental income
- Pre-organized medical records provided
- User-friendly portal and streamlined case management
- Full onboarding and ongoing support