Provide telework-based orthopedic surgery utilization review by evaluating the medical necessity of treatment requests and appeal cases. Reviews are advisory-only and do not establish a doctor-patient relationship or involve direct treatment, making this a flexible way to complete case-based physician work alongside an active practice.
Key Responsibilities
- Conduct medical necessity reviews for orthopedic surgery treatment requests.
- Review appeals for previously denied services.
- Provide advisory-only clinical opinions based on submitted medical records and treatment guidelines.
- Participate in peer-to-peer calls when needed for adverse determinations.
- Use a web-based portal to review organized case materials and documentation.
- Coordinate with support staff and peer coordinators on case flow and provider availability.
- Work through assigned cases on a per-case, availability-based schedule.
Required
- Current, unrestricted Texas medical license.
- Board certification in the relevant specialty.
- Active clinical practice.
- Orthopedic surgery specialty experience.
Preferred
- Experience with utilization review or medical necessity determinations.
- Prior experience with telework or remote physician review roles.
Benefits & Perks
- Independent contractor 1099 role with per-case compensation.
- Schedule flexibility and control over case volume.
- Telework arrangement that can be done from a remote setting.
- Streamlined case flow with a user-friendly work portal.
- Support for administrative tasks, records organization, and case preparation.
- Initial training and ongoing support contact.
- Chronological medical records and treatment guidelines provided for reviews.
- Peer coordinators assist with scheduling peer-to-peer calls when required.