Board Certified-(M.D, D.O) Oklahoma City Immunology Advisor, Certified for IME job opportunity at Dane Street.

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Dane Street Board Certified-(M.D, D.O) Oklahoma City Immunology Advisor, Certified for IME
Experience: 1-year
Pattern: full-time
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Advisory

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loacation Oklahoma City, Oklahoma, United States Of America
loacation Oklahoma City,..........United States Of America

As #Physician Reviewer/#Advisor for Independent Medical Exams (IME), you will utilize #clinical expertise and reviews insurance appeals, and 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. __ MAJOR DUTIES AND RESPONSIBILITIES: __ 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 __ Board certification required, active practice required

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