Physician Surgery-General - Competitive Salary
Company: Dane Street
Location: Grand Rapids
Posted on: July 8, 2025
|
|
|
Job Description:
Job Description 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 PLEASE BE AWARE:
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.
Keywords: Dane Street, Grand Rapids , Physician Surgery-General - Competitive Salary, Healthcare , Grand Rapids, Michigan
