Physician Reviewer MSK

WNS HealthHelp is seeking Board-Certified Orthopedic Surgeons specialized in musculoskeletal conditions and joint procedures (shoulder, hip, and knee) for high-impact case review roles.

At WNS HealthHelp, our mission is to collaborate with payors and providers to improve patient safety and deliver quality care through an evidence-based, educative, and collaborative model, focused on improving outcomes and reducing healthcare costs. We’re revolutionizing healthcare delivery by ensuring patients receive the most appropriate, cost-effective care while supporting healthcare providers in their decision-making process.

Role Overview

As a Specialty Physician Reviewer, you’ll leverage your clinical expertise to make significant impact on patient care and healthcare efficiency. In this role, you will :

• Conduct thorough reviews of complex musculoskeletal orthopedic cases, with emphasis on shoulder, hip, and knee procedures
• Provide valuable peer-to-peer consultations with treating physicians, fostering collaborative relationships and knowledge sharing within the medical community
• Ensure adherence to evidence-based guidelines and best practices, staying at the forefront of medical advancements in spine surgery
• Contribute to the continuous improvement of our utilization management processes, helping shape the future of healthcare delivery
• Exercise your clinical judgement to render well-reasoned decisions, based on evidence-based clinical criteria, including crafting comprehensive denial rationales when necessary.

Requirements

Preferred Qualifications

WNS HealthHelp provides cutting-edge technology to streamline the review process, including our proprietary HIPAA – compliant portal and Physician App, ensuring efficiency and ease of use for our specialists.

WNS HealthHelp is an Equal Opportunity Employer. At WNS HealthHelp, we celebrate diversity and are committed to creating an inclusive environment that extends to our suppliers and vendors. All qualified Independent Contractors will receive consideration without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other status protected under federal, state, or local law.