Board Certified-(M.D, D.O) Oklahoma City Cardiology Advisor-Certified for IME

About the role

As Physician Reviewer/Advisor you will utilize clinical expertise to review insurance appeals and prospective and retrospective claims. The Physician Reviewer will interpret the medical necessity of services provided by other healthcare professionals in compliance with client‑specific policies, nationally recognized evidence‑based guidelines, and standards of care.

Responsibilities

• Review all medical records and address each client question using client‑specific criteria or other nationally recognized evidence‑based criteria.
• Ensure the rationale for each determination is clear, concise, and supported by adequate documentation.
• Identify, critique, and utilize current criteria and resources such as national, state, and professional association guidelines and peer‑reviewed literature; avoid using case studies or cohorts with limited sample sizes for decisions.
• Provide copies of any criteria utilized in a review with the report in a timely manner.
• Return cases on or before the due date and time.
• Make telephone calls as mandated by state and/or client specifics.
• Maintain proper credentialing, state licenses, and any special certifications or requirements necessary to perform the job.
• Perform other duties as assigned, including responding to quality‑assurance issues, complaints, regulatory matters, depositions, court appearances, or audits.

Requirements

• Board certification (required).
• Active clinical practice (required).
• Current credentialing and state medical licenses.
• Any special certifications or requirements necessary for the role.

Benefits

• Robust opportunity for supplemental income.
• Enhanced industry expertise that strengthens your medical practice with medical‑necessity and utilization‑review expertise.
• Expanded credentials as an expert in Independent Medical Exams and physician‑advisor services.
• Fully prepped cases, streamlined case flow, transcription services at no cost, and a user‑friendly work portal.

Schedule

• Flexible and predictable work hours; you choose services and case types, dictate volume, and conduct exams and reviews based on your availability.
• No doctor‑patient relationship is established; work consists of advisory‑only opinions.