About the job
Dane Street, LLC is seeking a highly skilled and board-certified Orthopedic Surgeon to join our team as a Physician Reviewer/Advisor for Independent Medical Exams (IME) in Grand Junction, Colorado. In this critical role, you will leverage your clinical expertise to assess insurance appeals and review both prospective and retrospective claims. Your responsibilities will include evaluating the medical necessity of services rendered by fellow healthcare professionals, ensuring compliance with client-specific policies, as well as nationally recognized evidence-based guidelines and standards of care.
Key Responsibilities:
- Thoroughly review all medical records and address client inquiries using client-specific or nationally recognized evidence-based criteria.
- Provide clear and concise rationale for determinations, supported by adequate documentation.
- Critically analyze and utilize current national, state, and professional association guidelines, avoiding reliance on limited-sample size case studies.
- Timely provide copies of any criteria used in reviews with corresponding reports.
- Adhere to deadlines, returning cases on or before the specified due date.
- Conduct telephone calls as required by state regulations or client specifics.
- Maintain up-to-date credentialing, state licenses, and any special certifications required for the role.
- Participate in all mandatory orientations and training sessions.
- Perform additional duties as assigned, including addressing quality assurance issues, complaints, regulatory matters, depositions, court appearances, and audits.
Board certification and active clinical practice are required.
Why Join Us?
- Opportunity to earn supplemental income.
- Flexible scheduling and predictable work hours. You choose the types of services and cases, dictate volume, and conduct exams based on your availability.
- No direct doctor/patient relationship is established, and no treatment is provided—this role offers advisory-only opinions.
- Gain enhanced expertise in medical necessity and utilization review/management, strengthening your medical practice.
- Expand your credentials as an expert in Independent Medical Exams and physician advisor services.
- Enjoy streamlined case flow, fully prepared cases, free transcription services, and a user-friendly work portal.
Please note: In the interest of security for all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason, including the purchase of equipment.