Physician Reviewer - Musculoskeletal

HealthHelp; United States; Remote; USD 200,000 - 300,000; Full time

Job summary

An established industry player is looking for Board-Certified Orthopedic Surgeons to join their innovative team as Specialty Physician Reviewers. In this impactful role, you will leverage your clinical expertise to review complex musculoskeletal orthopedic cases, ensuring adherence to evidence-based guidelines. Collaborate with healthcare providers to enhance patient care and healthcare efficiency while utilizing cutting-edge technology to streamline the review process. This opportunity allows you to make a significant difference in the healthcare delivery landscape while supporting providers in their decision-making processes.

Qualifications

• Board certification in orthopedic surgery required.
• Active practice in musculoskeletal orthopedic surgery is essential.

Responsibilities

• Conduct thorough reviews of orthopedic cases focusing on shoulder, hip, and knee procedures.
• Provide peer-to-peer consultations with treating physicians.

Skills

Orthopedic Surgery

Clinical Judgment

Negotiation Skills

Communication Skills

Leadership Skills

Evidence-Based Practices

Education

MD or DO degree

Tools

HIPAA-compliant portal

Physician App

Job description

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 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 joint replacement and reconstructive 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

• MD or DO degree from an accredited school of medicine.
• Current, active, unrestricted license to practice medicine in a state or territory of the United States.
• Board certification in orthopedic surgery through ABMS/AOA.
• Active practice in musculoskeletal orthopedic surgery with focus on shoulder, hip, and knee procedures.
• Meets HealthHelp credentialing requirements.
• Ability to make outbound calls to providers as part of the case review process.
• Ability to collaborate with HealthHelp nursing and administration staff members.
• Excellent negotiation, leadership, and communication skills.
• Proficiency in using digital platforms for case review and communication.

Preferred Qualifications

• Academic affiliation.
• Participation in Interstate Medical Licensure Compact.
• Experience or familiarity with principles and procedures of utilization management in managed care.
• Ability to support flexible working hours.
• Experience and familiarity with government programs.
• Demonstrated ability to follow evidence-based practices in reviewing cases for medical appropriateness.
• Experience with joint replacement and reconstructive procedures.
• Expertise in both primary and revision joint surgery.
• Track record of applying evidence-based approaches to musculoskeletal conditions.

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.

Seniority level

Not Applicable

Employment type

Contract

Job function

Consulting, Administrative, and Health Care Provider

Industries

Insurance, Hospitals and Health Care, and Medical Practices