medical reviewer

Expertise Forge Connections Pvt. Ltd.

Job title: Physician Reviewer Schedule: M-F(8-5) Contract: 2+ Years Pay rate: $105/Hour on W2Description:<ul><li>This position requires an initial time commitment of at least 4 weeks to undergo and complete training.</li><li>After training, physician medical reviewer will provide weekend coverage, 8-hour shifts per Saturday and/or Sunday per month. Goal productivity of at least 32 cases per weekend day. This is a remote position.</li><li>Physician medical reviewer evaluates clinical service requests based on company guidelines to make medical necessity determinations.</li></ul>Required Qualification(s): <ul><li>Must be board Certified, M.D. or D.O with an unrestricted physician license in a state or territory of the United States.</li><li>Must demonstrate basic computer skills.</li></ul>Job Type: ContractPay: $100.00 - $105.00 per hourExpected hours: 40 per weekBenefits:<ul><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Referral program</li><li>Travel reimbursement</li><li>Vision insurance</li></ul>Work Location: Remote

Physician Reviewer

The HIRD

<div>
 
 
 Job Title:
 
 Medical Reviewer / Medical Quality Reviewer
 
 
 
 Location:
 
 Pune | NCR | Kolkata
 
 
 
 Working Model:
 
 Hybrid
 
 
 
 
 
 
 Qualifications:
 
 
 
 
 
 <ul>
 <li>
 MBBS (Medical Degree), preferably with a postgraduate qualification.
 </li>
 <li>
 Minimum
 
 2+ years of experience
 
 in clinical practice or pharmacovigilance (PV).
 </li>
 <li>
 Must hold valid
 
 Medical Doctor certification/licensure
 
 in the country of service.
 </li>
 <li>
 Experience in the pharmaceutical industry preferred.
 </li>
 <li>
 Working knowledge of
 
 international regulations and guidance documents
 
 related to worldwide reporting requirements (US/EU).
 </li>
 </ul>
 
 
 
 
 
 Key Responsibilities:
 
 
 
 
 
 <ul>
 <li>
 Perform comprehensive
 
 medical review
 
 of cases, ensuring consistency and accuracy of information.
 </li>
 <li>
 Provide
 
 causality assessment
 
 and
 
 clinical evaluation comments
 
 as required.
 </li>
 <li>
 Support the preparation of
 
 clinical trial safety assessments
 
 ,
 
 regulatory submissions
 
 , and
 
 aggregate safety reports
 
 .
 </li>
 <li>
 Ensure compliance with
 
 pharmacovigilance regulations
 
 and company policies.
 </li>
 <li>
 Identify and resolve issues independently; escalate complex matters appropriately.
 </li>
 <li>
 Demonstrate strong
 
 analytical and decision-making skills
 
 in both routine and complex scenarios.
 </li>
 <li>
 Collaborate effectively within a
 
 matrix organization
 
 , working both independently and under supervision.
 </li>
 <li>
 Maintain high productivity, organization, and time management to meet regulatory compliance goals.
 </li>
 <li>
 Exhibit
 
 excellent oral and written communication
 
 in English.
 </li>
 </ul>
 
 
 
 
 
 Skills &amp; Competencies
 
 
 <ul>
 <li>
 Strong understanding of
 
 pharmacovigilance processes
 
 and
 
 safety data management
 
 .
 </li>
 <li>
 Proficiency in
 
 database management systems
 
 and computer applications.
 </li>
 <li>
 Excellent organizational and problem-solving skills.
 </li>
 <li>
 Ability to work under tight timelines while maintaining quality standards.
 </li>
 </ul>
 
 
</div>

Medical Doctor

Dane Street

<div>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:<ul><li><ul>
<li>Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria</li>
<li>Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision</li>
<li>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</li>
<li>Provides copies of any criteria utilized in a review with the report in a timely manner</li>
<li>Returns cases on or before the due date and time</li>
<li>Makes telephone calls as mandated by the state and/or client specifics</li>
<li>Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job</li>
<li>Attends all required orientation and training</li>
<li>Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits</li>
<li>Board certification required, active practice required</li>
</ul></li></ul>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.
Benefits
Benefits<ul>
<li>Robust opportunity for supplemental income</li>
<li>Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability</li>
<li>No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions.</li>
<li>Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise</li>
<li>Expanded credentials as an expert in Independent Medical Exams and physician advisor services</li>
<li>Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal</li></ul></div>

Board Certified-(M.D, D.O) Oklahoma City Immunology Advisor, Certified for IME

iMPROve Health

<div>iMPROve Health is an seeking an Orthopedic Surgery Non-Spine physician to join our team in conducting independent medical reviews. As a peer reviewer, you&rsquo;ll play a vital role in enhancing the quality of health care by applying your clinical expertise to evaluate cases for medical necessity and quality of care.
This is a flexible, remote opportunity for clinicians who are passionate about maintaining the integrity of their specialty and supporting evidence-based practice.
BENEFITS:
<ul><li>Make a Difference: Use your clinical knowledge to improve the quality of care patients receive.</li>
<li>Professional Recognition: Join a network of highly respected experts in your specialty.</li>
<li>Competitive Compensation: Receive fair pay for your time and expertise.</li>
<li>Protect Standards of Care: Help uphold the integrity of your profession.</li>
<li>Work Remotely: Review cases from the convenience of your home or office.</li>
</ul>
DUTIES AND RESPONSIBILITIES:
<ul><li>Conduct objective, evidence-based peer reviews of clinical cases.</li>
<li>Make final determinations regarding medical necessity and quality of care.</li>
<li>Ensure decisions are fair, unbiased, and aligned with current standards of practice.</li>
<li>Submit reviews in a timely and professional manner using the IT systems provided.</li>
</ul>
QUALIFICATIONS:
<ul><li>Medical License: Must hold an unrestricted medical license in any U.S. state.</li>
<li>Board Certification: Required (if applicable), through a board recognized by:
<ul><li>The American Board of Medical Specialties (ABMS),</li>
<li>The American Osteopathic Association (AOA), or</li>
<li>Another nationally recognized board granting certification.</li>
</ul></li><li>Clinical Experience:
<ul><li>Have at least five (5) years full-time equivalent experience providing direct clinical care to patients.</li>
<li>Have experience providing direct clinical care to patients within the past three (3) years.</li>
<li>Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review.</li>
<li>Have the clinical expertise to manage the medical or behavioral health condition or disease under review.</li>
<li>Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify.</li>
</ul></li></ul>TECHNOLOGY REQUIREMENTS:
<ul><li>Reliable Wi-Fi access.</li>
<li>Proficiency with Microsoft Word.</li>
<li>Access to a computer compatible with iMPROve Health&rsquo;s IT systems.</li>
</ul>
OTHER REQUIREMENTS:
<ul><li>Must complete the electronic credentialing application and receive organizational approval prior to performing a case review.</li>
<li>Must complete a conflict of interest attestation upon credentialing and prior to performing a case review.</li>
<li>Active hospital medical staff privileges may be required, as applicable.</li>
<li>Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status.</li>
<li>Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews.</li>
</ul>
EOE/VET/Disability</div>

Peer Reviewer - Orthopedic Surgery Non-Spine Physician - remote

Institute for Building Technology and Safety (IBTS)

<div>Responsibilities:
<div>
The Plan Reviewer analyzes residential construction drawings, specifications, and documentation to ensure compliance with applicable building codes, with primary emphasis on the Federal Manufactured Housing Construction and Safety Standards (HUD Code). This position may also require the code compliance evaluation of residential and commercial construction projects.</div><div></div><div> 
The successful candidate must demonstrate a high level of organization, self-motivation, and strong interpersonal skills. Additionally, the candidate must possess the ability to establish and maintain professional relationships with colleagues, regulatory agencies, and the public while demonstrating integrity and sound judgment. The position requires proficiency in problem-solving and conflict resolution with minimal supervision, as well as excellence in communication, continuous learning, dependability, flexibility, leadership, planning and organization, reasoning and problem-solving, and teamwork.</div>
This position requires up to two weekly presences in the Ashburn, VA headquarters. 
<ul><li>
Conduct comprehensive analyses of architectural, structural, mechanical, thermal, electrical, energy, plumbing, and fire safety designs to ensure compliance with Federal Standards and Regulations governing manufactured housing</li><li>
Demonstrate an understanding of the standards referenced in the HUD Code such as National Fire Protection Association and American National Standards Institute</li><li>
Generate independent calculations, manually or other means, to verify the adequacy of performance-based design elements</li><li>
Collaborate with team members and colleagues to coordinate assignments, verify the accuracy of findings, and recommend corrective actions</li><li>
Research new and innovative design concepts or products and provide technical guidance to ensure compliance with applicable standards and quality requirements</li><li>
Provide technical guidance on manufactured home design and construction, and communicate findings through the internal design review process and external presentations</li><li>
Conduct professional development training to maintain current knowledge of standards, codes, and best practices and develop engaging content to enhance the skills and performance of colleagues and other in-house professionals</li><li>
Perform periodic quality control reviews of peer assignments and contract deliverables</li><li>
Support the maintenance of designs and records associated with plan review activities</li><li>
Assist in tracking assignments and gathering data to support status and performance reporting</li></ul>
Qualifications:
<ul><li>Bachelor&rsquo;s degree in Engineering, Architecture, or related field accredited by the Accreditation Board for Engineering and Technology (ABET)</li><li>
Minimum of five (5) years of experience in residential construction or factory-built housing (preferred), including knowledge of energy code regulations and compliance requirements, familiarity with all major building trades (framing, electrical, plumbing HVAC, etc.), understanding of quality assurance and quality control systems, and experience with building inspections and code enforcement.</li><li>
International Code Council Residential Plans Examiner certification or demonstrated ability to obtain certification within six (6) months of employment</li></ul>
Key Skills/Competencies for this position<div> 
Technical Competencies:</div><ul><li>
Comprehensive understanding of building codes and Federal Manufactured Housing Construction and Safety Standards</li><li>
Strong analytical and problem-solving capabilities with thorough attention to detail</li><li>
Ability to efficiently read and interpret complex plans, specifications, and blueprints</li><li>
Technical expertise and thoroughness in plan review processes</li><li>
Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint, and Adobe Acrobat</li></ul><div>
Professional Competencies:</div><ul><li>
Outstanding written and verbal communication skills for effective interaction with internal and external stakeholders</li><li>
Strong organizational and time management skills to prioritize tasks and meet deadlines efficiently</li><li>
Capability to manage dynamic and unpredictable workloads while adapting to changing priorities</li><li>
Ability to collaborate effectively as a team member and engage with all organizational levels</li><li>
Strong initiative and independence in carrying out responsibilities with minimal supervision</li><li>
Skilled in managing and resolving conflicts and disputes in a professional and constructive manner</li><li>
Continuous improvement mindset with commitment to learning and applying new strategies for professional growth</li><li>
Cultural competence with ability to respect and value diverse backgrounds and perspectives in the workplace</li></ul>
Personal Qualities 
IBTS places a high value on certain personal traits that work toward creating a positive, professional, and supportive work environment, which is essential for working together and achieving success. We believe &ldquo;how&rdquo; you achieve your results is as important as what you achieve. The following highlights the personal traits key for success within the organization.<ul><li>
Strong Work Ethic</li><li>
Teachable/Continuous Learner</li><li>
Reliable/Dependable</li><li>
Collaborative/Team Contributor</li></ul>
Physical Demands:
<ul><li>Extended periods of desk work and computer use</li><li>
Sufficient hearing and vision capabilities to effectively receive, process, and interpret information</li></ul>
Company Overview:
<div>
Bring your passion, expertise, and experience to IBTS, where we appreciate and are committed to our employees. We offer outstanding benefits, growth opportunities, and work hard to maintain a culture that values our employees.</div><div></div><div> 
The Institute for Building Technology and Safety (IBTS) is a 501(c) (3) non-profit organization established to provide unbiased professional building code compliance services, while enhancing the communities in which we work. At IBTS, our mission is to deliver quality services to meet the challenges of governance at all levels while enhancing public safety, economic development, and the general welfare of the community. Our services include Building and Community Development, Energy and Sustainability Services, Disaster Planning and Recovery, Quality Assurance, as well as Compliance and Risk Monitoring.</div><div></div><div> 
IBTS is headquartered in Ashburn, VA, with additional offices in Louisiana, Missouri, New York, Oklahoma, North Carolina, Texas, Puerto Rico, and Washington, DC.</div><div></div><div> 
We are committed to building a community of experts with diverse backgrounds, disciplines, and perspectives who are passionate about our mission. IBTS is proud to be an Equal Opportunity and Affirmative Action Employer that maintains a diverse and inclusive workforce. All qualified applicants will receive equal consideration for employment without regard to race, color, religion, sex, national origin, age, disability or sexual orientation. This opportunity is open to Section S3 Residents. Veterans and individuals with disabilities are encouraged to apply.</div><div></div><div> 
Explore the opportunities!</div></div>

Plan Reviewer

Neural IT

Experience: 6 months to 4 years Skills Required:<ul><li>Sound knowledge of Pharmacology.</li><li>Proper understanding of various disease process, abnormal laboratory results, diagnosis and treatment.</li><li>Writing skills required.</li><li>Computer Skills.</li><li>Verbal and written communication in English.</li><li>Medical Summarization with thorough knowledge of medicine based on experience of working in hospital and its associate processes.</li></ul>Roles &amp; Responsibilities:<ul><li>Analyzing and understanding of medical reports with compilation into a document to create a medical review.</li><li>To draft a case in a chronological order that includes patient's history, disease process, assessment and intervention.</li><li>The job involves medical review by electronic adaptation of patient health records.</li><li>Proper channelizing of disease process.</li><li>Managing and Monitoring a team of Doctors.</li></ul>Job Types: Full-time, PermanentPay: &#8377;30,000.00 - &#8377;40,000.00 per monthBenefits:<ul><li>Health insurance</li><li>Provident Fund</li></ul>Work Location: In person

BHMS/BAMS medical writer

ExamWorks

<div>SUMMARY
The Clinical Quality Assurance Coordinator is responsible for ensuring case reports are of the highest quality and integrity and in full compliance with client contractual agreements, regulatory agency standards and federal and state mandates. This position is required to handle quality assurance questions and provide support to the Quality Assurance Department.
ESSENTIAL JOB FUNCTIONS<ul><li>
Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews.</li><li>
Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.</li><li>
Ensure that all client instructions and specifications have been followed and that all questions have been addressed.</li><li>
Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.</li><li>
Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.</li><li>
Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report.</li><li>
Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists.</li><li>
Ensure the provider credentials and signature are adhered to the final report.</li><li>
Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed.</li><li>
Assist in resolution of client complaints and quality assurance issues as needed.</li><li>
Ensure all federal ERISA and state mandates are adhered to at all times.</li><li>
Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.</li><li>
Promote effective and efficient utilization of company resources.</li><li>
Participate in various educational and or training activities as required.</li><li>
Perform other duties as assigned.</li></ul>
MINIMUM REQUIRED QUALIFICATIONS
Education and/or Experience
High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience preferred. Knowledge of the insurance industry, preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, or disability preferred.
Certificates, Licenses, Registrations
LPN/LVN/RN may be required based on business needs.
ESSENTIAL COMPETENCIES
QUALIFICATIONS
<ul><li>Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.</li><li>
Must be a qualified typist with a minimum of 40 W.P.M</li><li>
Must have a full understanding of HIPAA regulations and compliance.</li><li>
Must be able to operate a general computer, fax, copier, scanner, and telephone.</li><li>
Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.</li><li>
Must demonstrate exceptional communication skills.</li><li>
Ability to follow instructions and respond to upper managements&rsquo; directions accurately.</li><li>
Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitors own work to ensure quality is met.</li><li>
Must be able to work independently, prioritize work activities and use time efficiently.</li><li>
Must be able to maintain confidentiality.</li><li>
Must be able to demonstrate and promote a positive team -oriented environment.</li><li>
Must be able to stay focused and concentrate under normal or heavy distractions.</li><li>
Must be able to work well under pressure and or stressful conditions.</li><li>
Must possess the ability to manage change, delays, or unexpected events appropriately.</li><li>
Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.</li></ul>
LANGUAGE/COMMUNICATION SKILLS
<ul><li>Ability to read, analyze and interpret common correspondence, medical records, and legal contracts and documents.
</li><li>Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.</li><li>
Ability to respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community.
</li><li>Ability to effectively present information one-on-one or in small groups.</li></ul>
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This position generally consists of:<ul><li>
Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs.</li><li>
Ability to operate a computer up to 4 hours at a time.</li><li>
Ability to travel to different floors of the office or other locations.</li><li>
Ability to move throughout the office.
</li><li>Occasionally lifting and/or carrying up to 10 lbs.</li><li>
Occasionally pushing/pulling up to 10 lbs.</li><li>
Occasionally subject to bending, squatting or twisting.</li></ul>
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.<ul><li>
Extended hours are occasionally required beyond the regular eight (8) hour work day.</li><li>
The noise level in the work environment is usually moderate.</li></ul></div>

Clinical Quality Assurance Coordinator

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