Medical Director - Neurosurgery - Remote

Lensa; Baltimore (MD); Remote; USD 238,000 - 358,000; Full time

Job summary

Join a forward-thinking organization as a Medical Director in Neurosurgery, where your expertise will directly impact health outcomes. This role offers the flexibility to work remotely while leading a dynamic claims review program. You'll engage with providers, oversee medical services, and ensure compliance with regulatory standards, all while contributing to health equity initiatives. With a competitive salary and comprehensive benefits, this is an opportunity to make a meaningful difference in the lives of patients and communities across the U.S.

Benefits

Comprehensive Benefits Package

Incentive Programs

Stock Options

401k Contributions

Qualifications

• 5+ years of clinical experience in Neurosurgery, including spinal surgery post-residency.
• Active, unrestricted medical license required.

Responsibilities

• Oversee quality and coordination of medical services for claims review.
• Participate in provider discussions and assist in policy development.

Skills

Neurosurgery

Clinical Experience

MS Office

Claim Coding

Interpersonal Skills

Education

MD or DO

Board Certification in Neurosurgery

Tools

Clinical Software

Claims Software

Job description

Medical Director - Neurosurgery - Remote

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Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

Optum, a global organization, delivers care aided by technology to help millions live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Our culture is guided by diversity and inclusion, with talented peers, comprehensive benefits, and career development opportunities. Join us to make an impact on the communities we serve as you help us advance health equity on a global scale. Come make a difference: Caring. Connecting. Growing together.

As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program. Responsibilities include overseeing the quality, effectiveness, and coordination of medical services, participating in provider telephonic discussions and appeals, and assisting in policy and procedure development for medical programs. The Medical Director acts as a liaison between Optum, physicians, and other medical service providers, primarily related to medical claim reviews.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on challenging tasks.

Primary Responsibilities

• Review surgical and other professional claims for correct coding using clinical records
• Participate in training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and other department-specific topics
• Discuss cases and clinical coding situations with treating providers telephonically during scheduled hours
• Participate in clinical conferences, calls, and internal performance reviews
• Prepare clinical summaries and rationales for medical necessity decisions when needed
• Be available for occasional weekend and holiday telephonic and remote clinical decisions
• Support compliance with regulatory standards (e.g., CMS, NCQA, URAC, state/federal, third-party payers)
• Travel to scheduled company meetings and activities within the US
• Assist in marketing presentations and ongoing client relationship management if requested
• Provide clinical support for staff conducting initial reviews
• Understand professional performance measurement and engage in discussions/interventions with providers/groups

You’ll be rewarded and recognized for your performance in an environment that challenges you, provides clear success criteria, and offers development opportunities.

Required Qualifications

• MD or DO
• Active, unrestricted medical license
• Board certification in Neurosurgery
• 5+ years of clinical experience in Neurosurgery, including spinal surgery post-residency
• Proficiency in MS Office (Word, Excel, PowerPoint)

Preferred Qualifications

• Experience in managed care
• Knowledge of professional claim coding and reviews
• Experience integrating clinical and financial data, developing utilization and performance reports, and communicating data to providers
• Knowledge of claim coding resources and techniques
• Computer skills and ability to learn clinical and claims software
• Excellent interpersonal skills for remote collaboration with physicians, nurses, PTs, OTs, and similar professionals
• Adherence to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $238,000 to $357,500 annually, based on experience and performance metrics. Benefits include comprehensive packages, incentive programs, stock options, and 401k contributions, subject to eligibility. We are committed to health equity and diversity, ensuring equitable care and opportunities for all.

UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates must pass a drug test prior to employment.