This is a fully remote position, open to applicants in Tennessee, +1 more state.

📋 Description

• Evaluate the medical necessity of treatment requests.

• Review the medical necessity of services that were previously denied during appeals.

• Conduct utilization reviews and provide advisory-only determinations and reports.

• Analyze medical records and treatment guidelines to make informed decisions.

• Manage a tailored caseload based on your scheduled availability.

• Engage in peer-to-peer discussions when required.

⛳️ Requirements

• Possession of a current, unrestricted Medical License in Tennessee or Texas.

• Active participation in medical practice.

• Board Certification is mandatory.

🏝️ Benefits

• The independent consultant position provides flexibility in scheduling and predictable work hours. You have the autonomy to select services and case types, manage volume, and perform this work according to your availability.

• There is no establishment of a doctor/patient relationship, and no treatment is administered. The role consists solely of providing advisory-only opinions.

• The typical turnaround time (TAT) ranges from 1 to 5 business days depending on the review level, with same-day cases being rare but possible. Dane Street will keep you informed of the required turnaround time and meticulously coordinate all administrative tasks, allowing you to focus on clinical decision-making.

• Dane Street ensures a seamless case flow and provides a user-friendly work portal. All communication is facilitated, medical records are organized and sorted, and all administrative processes are supported. We thoroughly prepare cases and guarantee the quality and timely delivery of all determinations and reports.

• A chronological compilation of medical records, along with all treatment guidelines utilized for determinations, is available in an accessible, click-to-view format.

• In instances where peer-to-peer calls are necessary (for adverse determinations), Dane Street’s peer coordinators will ensure provider availability.

• Dane Street provides initial training and offers a continuous point of contact for any questions related to completing reviews.