Job Description

HealthHelp is seeking Board-Certified Physicians with expertise in Diagnostic Imaging or related specialties to support utilization management case review activities on contract. We are particularly interested in candidates licensed in Oregon. At HealthHelp, our mission is to collaborate with payors and providers to improve patient safety and deliver high-quality care through an evidence-based, educational, and collaborative model. We are committed to ensuring patients receive the most appropriate, cost-effective care while supporting providers in clinical decision-making and improving healthcare outcomes. Role Overview As a Specialty Physician Reviewer – Diagnostic Imaging, you will apply your clinical expertise to evaluate medical necessity, support evidence-based care delivery, and partner with ordering providers through peer-to-peer consultation. In this role, you will: Perform comprehensive reviews of diagnostic imaging and related service requests Provide peer-to-peer consultation with ordering providers to promote appropriate utilization and collaborative care Apply evidence-based clinical guidelines and best practices in medical necessity determinations Support utilization management quality, compliance, and accreditation standards Render clear, well-reasoned determinations aligned with regulatory, contractual, and clinical criteria Requirements MD or DO degree from an accredited school of medicine Board certification in one of the following or a closely related specialty: Primary Imaging & Procedural Specialties Diagnostic Radiology Interventional Radiology Neuroradiology Nuclear Medicine Clinically Aligned Medical Specialties Internal Medicine Family Medicine Emergency Medicine Cardiology Physical Medicine & Rehabilitation Orthopedics Other specialties with significant imaging utilization experience may be considered Active, unrestricted U.S. medical license in the state of Oregon Current or recent U.S. clinical practice experience 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 Utilization Management case review experience 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 Commitment to an educational model in discussing and sharing clinical evidence with peers 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. Location - Remote Schedule - Completely Flexible Job Type - Contract WNS HealthHelp (A Capgemini Company) 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 (A Capgemini Company) 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.

Job Tags

Similar Jobs