Job description

Dane Street is looking for individuals to conduct Group Health reviews. This review will include a clinical summary, potential calls to the treating providers, and responses to questions posed.

The average length of time to review each case is between 15-20 minutes
The cases are prepared for you before they are provided for your review
There are times when calls will need to be made
Dane Street will help arrange any peer-to-peer phone calls, if needed.

Dane Street is also looking for individuals who would also be interested in participating in Panel Hearing calls. These calls require the physician to dedicate 1 hour of time. The calls are scheduled and set up for the physician(s). Panel Hearing calls are typically scheduled at least 2 weeks in advance to provide the physicians with plenty of notice.
Panel Appeal Hearings are a component of the referral assignment from one of our clients. Dane Street and its clients expect that reviewers will make a good-faith effort to assist in these panel hearings. These panel hearings are a required component of some of our specific referrals, and for Dane Street to assist, we need good physicians, like yourself, to assist in these panel hearings.

Here are some of the specific information you need to know about Panel Appeal Hearings:

Required to be onboarded for Group Health Review cases to be eligible for Panel Hearing calls
Block off 1 hour of your time

Most hearings last anywhere between 15-30 minutes

Receive higher compensation for Panel Appeal Hearings
Write up a report following the hearing
Follow the rules outlined by the client regarding the cadence of the call
Be an expert in the treatment of the covered person’s medical condition that is the subject of the external review.
Be knowledgeable about the recommended health care service or treatment through recent or current actual clinical experience treating patients with the same or similar medical condition of the covered person.

We are looking for the specialties listed below:

Pediatric Hematology
Pediatric Oncology
Pediatrics
Pediatrics Cardiology
Radiation Oncology
Allergy - Immunology
Developmental-Bahavioral Pediatrics
Diagnostic Radiology
Neuroradiology
Nuclear Medicine
Anatomic Pathology and Clinical Pathology
Bariatric Surgery
Cytopathology
Dermatological Pathology
Dermatology
OB/GYN-Obstetrics and Gynecology
Pain Management
Anesthesiology
Family Practice
Physical Medicine & Rehabilitation
Rheumatology
Sleep Medicine
Urology
Sports Medicine

MAJOR DUTIES AND RESPONSIBILITIES:

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; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes
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
Makes telephone calls as mandated by the state and/or client specifics
Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
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

Requirements