Provide remote utilization reviews for psychiatric treatment requests and appeals, offering objective, evidence-based opinions on medical necessity. This is a non-clinical review role with no patient contact, no treatment relationship, and no direct care delivery. Reviews are completed using workers’ compensation guidelines and nationally recognized criteria, with peer-to-peer calls and addenda as needed.
Key Responsibilities
- Review medical records to assess the medical necessity of requested services
- Use state-specific workers’ compensation guidelines and nationally recognized criteria
- Submit clear, concise, evidence-based determinations
- Complete reviews within required timeframes
- Participate in peer-to-peer calls when needed
- Complete addenda when additional information is submitted
- Work through a structured, pre-organized case management portal
Required
- Board certification in Psychiatry
- 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 case review
Benefits & Perks
- Fully remote work
- Independent contractor (1099) status
- Flexible scheduling and control over case volume
- Supplemental income with flat rate per case
- Pre-organized medical records provided for review
- User-friendly portal and streamlined case management
- Onboarding and ongoing support