Dane Street

Physician Reviewer

• Evaluate and review disability claims
• Telework opportunity from the convenience of home
• Join an independent physician panel of contract reviewers (1099)
• Enjoy flexible scheduling

Board Certified Disability Peer Physician Reviewer – Hematology

• Evaluate and review disability claims from home
• Participate as part of an independent physician panel of contract reviewers with flexible scheduling
• Focus on clinical decision-making without establishing a doctor/patient relationship

Board Certified Disability Peer Physician Reviewer – Gastroenterology

• Utilize medical expertise to conduct thorough reviews of clinical cases
• Evaluate medical records and provide clinical summaries
• Engage in peer communications and answer specific questions posed by clients

Board Certified Allergy Immunology Physician – Disability Peer Reviewer

• Evaluate and review disability claims
• Conduct work from the convenience of home
• Enjoy flexible scheduling and balance work with lifestyle

Board Certified Cardiology Disability Peer Reviewer

Customer Support

• Handling Receipt of New Cases:
• Intake new cases and review/verify information and requests. Draft cases by entering information into the Dane Street system, AccessDS.
• Work with client on any information missing pertinent to processing claim.
• Sort, organize and create medical document listing - if required by client, and in line with specific special handling.
• Oversight of Cases:
• Monitor, process and track cases to ensure we meet deadlines.
• Assignment of Cases:
• Assign/schedule new cases to physicians for review with the appropriate physician, based on location, reviewer availability, specific guidelines, jurisdictional requirements and other client requirements.
• Ensure that the assigned physician has no conflict of interest with the case assignments.
• Client Interaction:
• Update clients frequently on cases in progress.
• May communicate when there are questions on referral information to ensure proper documentation and information is provided to the assigned reviewer.
• Ensure proper documentation for specified cases is provided to the client.

Group Health Customer Service Representative

General

• conduct thorough reviews of clinical cases
• evaluate medical records
• provide clinical summaries
• engage in peer communications
• answer specific questions posed by clients

Board Certified Physician Reviewer – Pulmonary Disease

Supervisor

• The CSR Supervisor is responsible for managing the various aspects of the medical file review process, specifically the intake, turn-around time and the supervision of the Customer Service Representative team.
• Oversight of File Review to ensure that cases are properly notated and are processed timely.
• Provide guidance on cases where there are questions on assignment and process handling.
• Conduct monthly audits on staff to ensure that goals are met and coaching/training is provided when required.
• Provide guidance and resolution to issues brought to the attention of the supervisor.
• Train new team members on case workflow, processes and client specific requirements.
• Conduct one on one meetings with staff for progress meetings and to provide feedback.
• Participate in writing initial and annual reviews of staff members. May provide input into the hiring & firing process.
• Provides updates to clients frequently on cases in progress.
• Responds to clients when there are questions on referral information to ensure proper documentation and information is provided to the assigned reviewer.
• Ensure proper documentation for complex cases is provided to the client.
• Provide exceptional customer service to clients. ********

Group Health CSR Supervisor

Reviewer

• Evaluate medical records
• Prepare concise clinical summaries
• Provide independent medical opinions in response to specific client questions
• Assess medical necessity, causation, work-relatedness, impairment, disability status, return-to-work recommendations, and appropriateness of treatment
• Conduct evidence-based clinical assessments
• Prepare clear, comprehensive written reports
• Participate in peer-to-peer discussions when necessary
• Answer client-specific questions regarding occupational injuries, illnesses, and workplace health concerns
• Apply current clinical guidelines and standards of care to all reviews

Occupational Medicine Reviewer

• Evaluate and review disability claims from home
• Work with a panel of independent physicians
• Maintain flexibility in scheduling and workload

Neuro-Ophthalmology Disability Peer Reviewer

Recruitment

• Identify and vet specialty physicians (All specialties, including Orthopedic Surgeons, Neurologists, PM&R, etc.), ensuring full state coverage in California.
• Maintain working knowledge of physician networks and recruitment processes.
• Collaborate with healthcare and insurance organizations to streamline recruitment efforts.
• Utilize computer platforms to analyze network gaps and optimize recruitment efficiency.
• Manage relationships with high-level medical specialists for recruitment initiatives.

Physician Recruiter – California QME

• 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
• 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
• Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job (TX license is Required)
• 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

Physician Reviewer – Texas Counter Affidavit Work, Orthopedic Surgery

• Conduct Independent Medical Exams and Peer Reviews
• Customize schedule and caseload within a Monday - Friday work week
• Ensure compliance with state regulations and evidence-based guidelines
• Review medical records addressing client questions
• Maintain proper credentialing, licenses, and certifications
• Attend required orientation and training
• Identify and respond to quality assurance issues and complaints
• Provide copies of criteria utilized in reviews promptly

Physician Reviewer – Internal Medicine

• Review requests for Prior Authorizations and Appeals including medical records and make a medical necessity determination in compliance with state regulations, nationally recognized evidence-based guidelines, and client-specific policies.
• Ensure clear, concise, and well-supported rationales for determinations.
• Make mandated phone calls.
• Provide responses in member friendly language using provided templates.
• Return cases on or before the due date and time.
• Assist with quality assurance of reports prior to submission to clients.
• Maintain proper credentialing, state licenses, and any special certifications
• Utilize current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature for decision-making.
• Identify and respond to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits.
• Provide copies of any criteria utilized in a review with the report.
• Other duties & special projects, as assigned and based on business needs.

Utilization Management Physician Reviewer

• Review medical records to determine the medical necessity of services
• Utilize state-specific workers’ compensation guidelines and nationally recognized criteria
• Submit clear, concise, and well-supported determinations
• Complete reviews within required timeframes (typically 1–5 business days)
• Participate in peer-to-peer calls as needed (coordinated by Dane Street)
• Complete addenda when new information is provided