Independent Medical Exam IME Doctor- Board-Certified Ortho Surgery (M.D., D.O.)

Requirements

• Hold a NY license
• Be Board Certified in Orthopedic Surgery
• Have experience in completing Independent Medical Exams
• Be New York State Workers' Comp certified

Major Duties and Responsibilities

• Utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims
• Provide an interpretation of 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
• Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria
• Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision
• Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes
• Provides 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

Qualifications

• Board Certification in Orthopedic Surgery
• Active Practice Required

Skills

• Medical Necessity Review
• Independent Medical Exams
• Compliance with Client Policies
• Nationally Recognized Evidence-Based Guidelines
• Peer-Reviewed Literature

Benefits

• Robust opportunity for supplemental income
• Schedule flexibility and predictable work hours
• No doctor/patient relationship is established and no treatment is provided
• Enhanced industry expertise strengthening your medical practice
• 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

Pay

Details about pay are not specified in the job posting.

Schedule

Schedule flexibility and predictable work hours are offered.