A duly licensed doctor of medicine or doctor of osteopathic medicine in the State of Washington responsible for clinical oversight of the independent medical examination services, including the credentialing of professional staff and physician advisors and quality management and improvement, as well as, other clinical functions. L&I approval required and experience handling cases for Labor and Industries is preferred.

Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

MAJOR DUTIES & RESPONSIBILITIES

• Perform annual quality assurance audits of assignments to ensure appropriate reviewers are assigned to cases, and to provide quality assurance reports to the Insurance Department when requested. Act as a resource to the IME Operations Team in potential areas of dispute. Attend client facing meetings when appropriate. Interface with the Labor and Industries staff when requested.
• Perform annual quality assurance audits to ensure appropriate reviews are conducted, and to provide quality assurance reports to the Insurance Department when requested.
• Perform annual review and approval of clinical review criteria.
• Serve as the clinical lead for the Washington Independent Medical Examination Services division. The National Medical Director must be easily accessible to clients, physician advisors, Assistant Medical Directors and clinical and non-clinical staff.
• Assist the IME Department with quality assurance of reports prior to submission to clients. Perform medical record file preparation, including but not limited to, sorting, listing and summarizing. Manage and train medical preparation vendors to ensure timely and accurate medical record files and summaries.
• Perform random case audits in accordance with company policy or client specifications. Perform case audits for newly credentialed physician advisors, as well as, random cases from veteran physician advisors, in accordance with policy IRO-09, Performance Monitoring.
• Serve as clinical lead for all URAC accreditations. Work closely with the Chair of the Quality Management and Credentialing Committee (QMC). Must attend at least two virtual QMC meetings per year.
• Approve, or manage approval by physician Credentialing Committee members, of company’s clinical review criteria or scripts, if applicable, and national or regional medical treatment guidelines used for Workers’ Compensation or Group Health utilization reviews.
• Work directly with the credentialing team in overseeing the credentialing of physician advisors.
• Other duties & special projects, as assigned and based on business needs.

EDUCATION/CREDENTIALS:

Board Certified M.D. or D.O. with current, unrestricted clinical license in any State in the U.S.

JOB RELEVANT EXPERIENCE:

Minimum five years postgraduate experience. Extensive clinical business background required. Experience working with Worker’s Compensation and Group Health claims and Utilization Review standards and guidelines.

JOB RELATED SKILLS/COMPETENCIES:

Working knowledge of URAC and relevant State and Federal compliance guidelines. Excellent communication skills, understanding of medical terminology, critical thinking, ability to manage time efficiently and to meet specific deadlines. Computer literacy and typing skills required. 

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services. 

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

This job description is subject to change at any time.