Protocol Specialist

About the role

The Protocol Specialist translates deep orthotic and prosthetic clinical experience into the structured decision logic that powers our AI platform. You are the bridge between what clinicians know and what our systems need: you map clinical evaluation findings to medical necessity criteria, define the decision paths that determine appropriate device selection, and ensure every protocol we ship is defensible against LCD policy and payer scrutiny.

Responsibilities

• Develop clinical protocols for each device category: required evaluation, criteria to document, medically appropriate devices, and work order contents.
• Map clinical evaluation form fields to medical necessity criteria from LCDs and policy articles — so a completed evaluation automatically satisfies documentation requirements.
• Define the structured evaluation modules for Hike Clinical: what questions to ask, in what sequence, and what each answer implies for device selection and coding.
• Work with the Clinical Intelligence Lead so completing an evaluation automatically generates the right L-codes and auth packet.
• Review and sign off on agent guide content for clinical accuracy.
• Stay current with clinical evidence, outcomes research, and guideline changes in O&P and relevant DME categories.

Requirements

A licensed clinician (ABC/BOC certified orthotist/prosthetist, PT, OT, or equivalent) OR deep clinical policy experience (5+ years in utilization management, medical policy, or clinical documentation for DMEPOS).

Direct knowledge of AFO and lower-extremity orthotic indications: rigid/solid, articulated, carbon fiber, spiral, floor reaction, SMO, KAFO — including when each is appropriate and how it's documented.

Familiarity with CMS LCD L33686 and Policy Article A52457; working knowledge of the five-criterion custom fabrication rule.

Ability to write precise structured protocols, not just clinical notes.

Experience at an O&P practice, health system, or payer (medical policy team at a major insurer also strong).

Qualifications

Compensation Range: $150K - $210K