Board-certified rheumatology physician to review independent medical exams (IMEs), insurance appeals, and prospective/retrospective claims, assessing medical necessity and adherence to evidence-based guidelines and client policies. Responsible for interpreting services provided by other healthcare professionals and providing clinical opinions in line with standards of care. Serves as a physician reviewer/advisor to support utilization review, appeals adjudication, and medico-legal determinations.
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.
rheumatology, medical review, independent medical exam, insurance appeals, utilization review, medical necessity, claims review, evidence-based guidelines, clinical consultation
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