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Remote MD DO Orthopedic Surgeon Case Review UR in Chicago

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Job Ref:  311353759
Employer:  Network
Company Name:  Julia Edmunds Associates, Inc
Industry:  Healthcare other
Job Type:  Full Time
State:  Illinois
City:  Chicago
Zip Code:  60601
We are currently recruiting an Orthopedic Physician Case Reviewer. This is a full time opportunity however part- time of 25+ hours per week is also available.
General orthopedics or a specialty area such as spine, hips, knees, etc.

Work from any location in the USA!!!!!!!!

Must be available Mon-Fri between the hours of 8AM and 5PM
Part -Time Hours available Mon-Fri - Afternoons and Evenings
OR can work 2 10 hour days
No Nights, Weekends or Holidays!

Will participate in pre-authorization and quality improvement solutions for orthopedic and diagnostic imaging solutions.

Will determine the medical necessity of outpatient requests using clinical appropriateness guidelines and health plan medical policy.

*Perform physician-level case review, following initial nurse review, of orthopedics and high-tech diagnostic imaging requests.
*Determine medical necessity of requests using Clinical Appropriateness Guidelines and client-specific health plan medical policy
*Conduct peer-to-peer consultations with ordering physicians, physician assistants, and advanced practice nurses to provide education regarding established guidelines and accepted standards of care regarding studies and site of service.
*Suggest alternative treatments, studies and sites of care to ordering providers when appropriate
*Provide support and educate clinical and non-clinical staff to foster understanding of the principles associated with appropriate use of covered oncology and diagnostic imaging modalities.
*Actively participate in physician team meetings.
*Demonstrate and maintain knowledge of relevant policies and regulations pertaining to orthopedics and imaging modalities.
*Actively participate in groups that develop, revise and enhance clinical appropriateness guidelines
*Perform first level provider appeals of coverage decisions.


Must be licensed as a MD or DO
Must be Board Certification in Orthopedics by American Board of Orthopedics
Demonstrated knowledge of current practice standards

Attractive salary and 4% Bonus

Comprehensive Benefit package including 401k, Medical, Health, Life and Dental insurance, PTO, CME credits, license renewals.etc.