Board Certified Internal Medicine Physicians for IME Cases- Delaware

About the role

Dane Street is expanding its physician panel to offer an in-person opportunity for supplemental income. Physicians will provide a customized caseload based on their schedule.

Responsibilities

• Utilize clinical expertise to review insurance appeals and prospective and retrospective claims.
• Interpret medical necessity of services provided by other healthcare professionals in compliance with client-specific policies, nationally recognized evidence-based guidelines, and standards of care.
• Review all medical records and address questions posed by the client using client-specific criteria or other nationally recognized evidence-based criteria.
• Ensure the rationale for determinations is clear, concise, and contains adequate supporting documentation to substantiate the decision.
• Identify, critique, and utilize current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature to support sound and objective decision-making and rationales in reviews.
• Provide copies of any criteria utilized in a review with the report in a timely manner.
• Returns cases on or before the due date and time.
• Makes telephone calls as mandated by the state and/or client specifics.
• Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job.
• Attends all required orientation and training.
• Performs other duties as assigned, including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
• Board certification required, active practice required.

Requirements

• Holds a CA license and is Board-Certified in Internal Medicine, Family Medicine, or Occupational Medicine.
• Works within the state of Delaware.

Qualifications

• Experience in medical necessity and utilization review/management.
• Expertise in Independent Medical Exams and physician advisor services.

Skills

• Strong clinical expertise.
• Ability to interpret medical necessity and guidelines.
• Knowledge of national, state, and professional association guidelines.
• Effective communication skills.

Benefits

• Robust opportunity for supplemental income.
• Schedule flexibility and predictable work hours.
• No doctor/patient relationship established.
• No treatment provided.
• Enhanced industry expertise.
• Expanded credentials as an expert in Independent Medical Exams and physician advisor services.
• Prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal.
• Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery.

Pay

Details on pay are not specified in the job posting.

Schedule

Schedule flexibility and predictable work hours are offered.