WNS HealthHelp is seeking Board-Certified Geneticists specialized in genetic testing and counseling for 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 genetic testing cases
• 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 genetics
• 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 adverse determination rationales when medically necessary.

Requirements

• MD, DO degree from an accredited school of medicine or hold a doctoral degree (Ph. D.) in genetics, genomics, or human genetics
• Current, active, unrestricted license to practice medicine in a state or territory of the United States
• Board certification in Medical Genetics and Genomics (ABMGG)
• Active practice in genetics specialty in the United States
• 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

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.