Lumetra Healthcare Solutions is an independent case review organization in California.   We are seeking specialists to perform peer review of electronic health records for our contract with the DMHC  The State of California  Department of Managed Healthcare.  We're currently expanding our panel nationally and are  looking specifically for California licensed clinicians in all specialties to perform case reviews. Interested clinicians must be in active practice, have five years of direct clinical experience and will be required to complete the credentialing process prior to assignment of any cases for reviews. The majority of case review types may include medical necessity, experimental/investigational, or reimbursement of emergency care.

The Reviewer specifically evaluates appeals of cases that have been denied/delayed or modified by a managed care health Plan.

Briefly, this case review work includes the following:

• Your role is as a contracted reviewer who must be licensed in California.

• No litigation is involved.

• Reimbursement is $100/hr, but not to exceed 2 hours per case. 

• Reviews will take less than 1 hour to complete.

• Reviews involve remotely accessing medical files.   It is essential that the reviewer is confident with review of electronic health records.