Ophthalmology Physician

Physician Reviewer/Advisor for Independent Medical Exams (IME)

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and review insurance appeals, as well as prospective and retrospective claims. The Physician Reviewer will 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.

Job Description

• Review all medical records and address each question posed by the client utilizing client-specific criteria or other nationally recognized evidence-based criteria
• Ensure that the rationale for the determination 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 that support sound and objective decision-making and rationales in reviews; refrain from using case studies, cohorts, and the like to make decisions due to their limited sample sizes
• 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 the state and/or client specifics
• Maintain proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
• Attend all required orientation and training
• Perform other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits

Requirements

• Board certification required
• Active practice required

Important Note

In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment.