Dane Street

Analyst

• Conduct thorough reviews of clinical cases
• Evaluate medical records
• Provide clinical summaries
• Engage in peer communications
• Answer specific questions posed by clients
• Deliver advisory-only opinions without establishing a doctor/patient relationship or providing treatment

Physician Reviewer – Board Certified Behavioral Analyst (BCBA-D)

Medical Director

• Provide clinical oversight and subject matter expertise for behavioral health utilization review activities.
• Audit initial cases completed by newly onboarded behavioral health physician reviewers and provide feedback, coaching, or retraining when needed.
• Perform ongoing and targeted audits of behavioral health panelists based on quality trends, client grievances, overturn patterns, escalations, or other identified performance concerns.
• Review potential quality misses or inappropriate determinations and provide timely clinical feedback and remediation to physician reviewers.
• Support QA and operational staff with live case escalations involving behavioral health determinations, rationale quality, evidence-based support, peer-to-peer requirements, or reviewer performance.
• Monitor remediation effectiveness and provide follow-up guidance when quality concerns persist.
• Assist with behavioral health reviewer training and maintenance of reviewer training expectations and documentation.
• Participate in quality management and quality improvement activities related to behavioral health review services.
• Respond to client escalations or grievances involving behavioral health physician determinations and assist with root-cause review and remediation plans.
• Participate in client-facing calls, audits, and touch-base meetings as the behavioral health physician subject matter expert, including discussion of clinical quality, reviewer performance, and corrective actions.
• Participate in prospective client discussions as needed to provide physician perspective regarding behavioral health capabilities, panel oversight, and quality monitoring.
• Collaborate with Group Health leadership, Medical Director leadership, QA, operations, and physician network teams to support consistent, high-quality behavioral health utilization review.

Associate Medical Director, Behavioral Health

Physician

• Address the medical necessity of treatment requests
• Address the medical necessity of previously denied services in appeals
• Complete utilization reviews and provide advisory-only determinations/reports
• Review medical records and treatment guidelines to make determinations
• Complete a customized caseload according to scheduled availability
• Participate in peer-to-peer calls when necessary

Board Certified Physician Reviewer – Urology

Board Certified Physician Reviewer, Multiple Specialties

• Conduct thorough reviews of clinical cases using medical expertise
• Evaluate medical records
• Provide clinical summaries
• Engage in peer communications
• Answer specific questions posed by clients
• Deliver high-quality healthcare assessments and timely determinations/reports

Board Certified Physician Reviewer – Dentistry

Board Certified Physician Reviewer – Radiation Oncology

Medical Reviewer

• Conduct thorough reviews of clinical cases
• Evaluate medical records
• Provide clinical summaries
• Engage in peer communications
• Answer specific questions posed by clients
• Deliver advisory-only medical opinions without establishing a doctor/patient relationship or providing treatment

Board Certified Physician Reviewer – Medical Oncology

• Conduct thorough reviews of clinical cases
• Evaluate medical records
• Provide clinical summaries
• Engage in peer communications
• Answer specific questions posed by clients
• Deliver advisory-only medical opinions and determinations/reports

Board Certified Physician Reviewer – Sleep Medicine

• Conduct thorough reviews of clinical cases
• Evaluate medical records
• Provide clinical summaries
• Engage in peer communications
• Answer specific questions posed by clients

• Conduct thorough reviews of clinical cases
• Evaluate medical records
• Provide clinical summaries
• Engage in peer communications
• Answer specific questions posed by clients
• Deliver high-quality healthcare assessments and determinations/reports

Board Certified Physician Reviewer – Hematology/Medical Oncology

• Conduct comprehensive reviews of dental and medical records
• Provide objective, evidence-based advisory opinions
• Review medical and dental records
• Evaluate clinical documentation and treatment plans
• Prepare clear and concise clinical summaries
• Respond to specific client questions related to oral and maxillofacial surgery and dental care
• Perform advisory medical record reviews only; no peer-to-peer discussions, telephone calls, direct patient care, or treatment
• Apply specialized oral and maxillofacial surgical and clinical expertise to support high-quality, accurate, consistent, and defensible healthcare assessments

Oral and Maxillofacial Surgeon – Clinical Reviewer

• Conduct thorough reviews of clinical cases
• Evaluate medical records
• Provide clinical summaries
• Engage in peer communications
• Answer specific questions posed by clients
• Deliver high-quality healthcare assessments

Board Certified Physician Reviewer – Hematology

Recruitment

Job Summary
The Phyisican Recruiter is responsible for maintaining and expanding Dane Street’s physician panel. This includes negotiating physician fees within pre-established guidelines, onboarding new physicians based on client demand, and ensuring that all open service requests (OSRs) are resolved promptly. The ideal candidate will leverage existing relationships and industry knowledge to strategically grow the network and support business operations.

Key Responsibilities
Panel Maintenance & Growth
 
- Understand client fee schedules and turnaround time (TAT) requirements to negotiate physician agreement terms. 
 
- Conduct outreach for refunds or recoupments; collaborate with Finance and Legal when collections are required. 
 
- Maintain existing physician records, including: 
 
- Fee updates 
 
- W9 and remittance changes 
 
- Profile instructions 
 
- Doctor groups 
 
- Deactivations/reactivations 

- Research and source new panel options as needed. 
 
- Onboard new physicians based on client needs.
 
- Negotiate rates and contract terms per company guidelines. 
 
- Collect necessary documentation (agreements, CVs, applications, W9s, NPDB reports). 
 
- Coordinate with the Director of Operations to finalize fees. 

Special Assignments & Contract Negotiations
 
- Lead contract renegotiations for existing physicians (agreements, pricing changes, special initiatives). 
 
- Handle complex client requests, especially those involving niche specialties or urgent network gaps. 
 
- Assist physician reviewers with technical issues or case-specific inquiries. 
 
- Fulfill high-priority OSRs by recruiting appropriate specialists and providing daily updates on progress. 
 
- Collaborate with operations to ensure network alignment with business needs. 
 
Additional Duties
 
- Support other projects and tasks as assigned by leadership. 
 
- Stay current on industry trends and compliance requirements. 
 
Qualifications
Education:

- Associate's or Bachelor's degree preferred. 

Experience:
 
- 3–5 years of physician recruitment experience in a healthcare or insurance environment. 
 
- Familiarity with provider networks and healthcare operations is strongly preferred. 
 
Skills & Competencies:
 
- Deep understanding of physician recruitment, medical specialties, and related terminology. 
 
- Strong negotiation and communication skills. 
 
- Working knowledge of federal/state healthcare compliance standards. 
 
- Excellent time management, critical thinking, and organizational abilities. 
 
- Proficiency in Microsoft Office and general computer systems. 
 
Working Conditions
 
- Primarily remote with extended periods of computer work. 
 
- Occasional lifting, bending, or travel may be required depending on business needs. 
 
Technical Requirements (Remote Work)
 
- Must supply and maintain reliable, high-speed internet. 
 
- An uninterrupted internet connection is a requirement for this role. 

This job description is not intended to be all-inclusive. Duties and responsibilities may be adjusted based on evolving business needs.

Physician Recruiter

• Conduct comprehensive reviews of clinical cases
• Apply dental expertise to provide objective, evidence-based medical advisory opinions
• Review medical records and dental documentation
• Prepare clear and concise clinical summaries
• Respond to client questions related to dental care
• Perform advisory medical record reviews only, without peer-to-peer discussions, calls, or direct patient care
• Support high-quality, objective, and defensible medical determinations

Dental Clinical Reviewer

• Conduct comprehensive reviews of clinical cases
• Apply orthopedic and spine expertise to provide objective, evidence-based medical advisory opinions
• Review medical records and clinical documentation
• Prepare clear and concise clinical summaries
• Respond to specific client questions related to orthopedic and spine care
• Perform advisory medical record reviews only; no peer-to-peer discussions, calls, or direct patient care
• Support high-quality, objective, and defensible medical determinations

Physician Reviewer – Board Certified Behavioral Analyst (BCBA-D)

Associate Medical Director, Behavioral Health

Board Certified Physician Reviewer – Urology

Board Certified Physician Reviewer, Multiple Specialties

Board Certified Physician Reviewer – Dentistry

Board Certified Physician Reviewer – Radiation Oncology

Board Certified Physician Reviewer – Medical Oncology

Board Certified Physician Reviewer – Sleep Medicine

Board Certified Physician Reviewer – Medical Oncology

Board Certified Physician Reviewer – Hematology/Medical Oncology

Oral and Maxillofacial Surgeon – Clinical Reviewer

Board Certified Physician Reviewer – Hematology

Physician Recruiter

Dental Clinical Reviewer

Orthopedic Spine Surgeon – Clinical Reviewer