This physician reviewer role focuses on remote utilization review for physical medicine and rehabilitation cases, evaluating the medical necessity of treatment requests and appeals for workers’ compensation. The work is non-clinical and does not involve patient contact, treatment, or an ongoing doctor-patient relationship. Reviews are completed using state-specific workers’ compensation guidelines and nationally recognized criteria, with support for peer-to-peer calls and addenda when new information is submitted.
Key Responsibilities
- Review medical records to determine the medical necessity of requested services
- Apply state-specific workers’ compensation guidelines and nationally recognized review criteria
- Submit clear, concise, and well-supported utilization review determinations
- Complete reviews within required turnaround times
- Participate in peer-to-peer calls as needed
- Complete addenda when additional information is provided
Required
- Board certification in Physical Medicine and Rehabilitation
- Active, unrestricted New York medical license
- New York Workers’ Compensation Board Certification
- Active clinical practice
Preferred
- Prior utilization review or independent medical review experience
- Experience with workers’ compensation cases
Benefits & Perks
- Fully remote work
- Flexible scheduling with control over volume and availability
- Independent contractor (1099) arrangement
- 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