Physician Reviewer, Neurological Surgery - NV

Summary: This role is for a Physician Reviewer/Advisor specializing in neurological surgery, offering telework opportunities for physicians to provide advisory opinions on medical necessity based on clinical treatment guidelines. The position allows for flexible scheduling and is compensated on a per-case basis, requiring candidates to hold a Nevada Medical License. The role involves reviewing medical records, ensuring compliance with guidelines, and providing clear documentation for decisions made.

Key Responsibilities:

• Reviews all medical records and addresses each question posed utilizing client-specific criteria or other nationally recognized evidence-based criteria
• Ensures a clear rationale for determination that is concise and contains adequate supporting documentation to substantiate the decision
• Identifies and employs 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 a report and copies of any criteria utilized within the review promptly
• Returns cases on or before the due date and time specified
• Completes calls/call attempts as mandated by the state and/or client specifics
• Maintains proper credentialing, required licenses, and any special certifications and adheres to requirements necessary to perform in the role of Physician Reviewer/Advisor
• Attends required orientation and training
• Performs other duties as assigned including identifying and responding to potential quality assurance issues, complaints, and regulatory issues

Key Skills:

• Medical degree (M.D. or D.O.) with a valid Nevada Medical License
• Clinical expertise in reviewing medical necessity and treatment guidelines
• Ability to interpret and apply evidence-based clinical criteria
• Strong documentation and communication skills
• Experience in quality assurance and regulatory compliance
• Flexibility in scheduling and managing caseloads
• Proficiency in using medical review software and tools

Salary (Rate): undetermined

City: undetermined

Country: undetermined

Working Arrangements: remote

IR35 Status: outside IR35

Seniority Level: undetermined

Industry: Other