Medical Director - Neurosurgery - Remote

Lensa; Sacramento (CA); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare provider is seeking a Medical Director for Neurosurgery to oversee claims review programs. This remote position requires strong clinical experience and leadership skills. The role involves ensuring quality medical services and engaging with healthcare providers. Join a team committed to enhancing community health and advancing health equity.

Benefits

Comprehensive Health Plans

Incentive Programs

Stock Options

401(k)

Qualifications

• At least 5 years of clinical Neurosurgery experience, including spinal surgery post-residency.

Responsibilities

• Review surgical and professional claims for correct coding based on clinical records.
• Engage in clinical conferences and performance reviews.
• Support compliance with regulatory standards.

Skills

Interpersonal Skills

Clinical Neurosurgery

Claim Coding Knowledge

Education

MD or DO Degree

Board Certification in Neurosurgery

Tools

MS Office

Job description

Medical Director - Neurosurgery - Remote

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Lensa, a leading career site, connects job seekers at every career stage with opportunities. Our client, UnitedHealth Group, is seeking qualified professionals. Apply via Lensa today!

Optum, a global organization, delivers care enhanced by technology to help millions live healthier lives. Your work will directly impact health outcomes by connecting people with necessary care, pharmacy benefits, data, and resources. We promote a culture of diversity and inclusion, offering comprehensive benefits and career growth opportunities. Join us to make a difference in community health and advance health equity worldwide.

Position Overview: As part of the Focus Claims Review team at Optum, the Medical Director provides leadership and oversight for the claims review program. Responsibilities include ensuring the quality and effectiveness of medical services, engaging in provider discussions and appeals, and developing policies and clinical criteria. The role acts as a liaison between Optum, physicians, and medical providers, primarily related to medical claim reviews.

Work Environment: Remote work from anywhere in the U.S., with occasional travel for meetings and client engagements.

Primary Responsibilities

• Review surgical and professional claims for correct coding based on clinical records.
• Participate in training on URAC, NCQA, regulatory compliance, confidentiality, and related topics.
• Discuss cases with providers telephonically during scheduled hours.
• Engage in clinical conferences and performance reviews.
• Prepare clinical summaries and rationales for medical necessity decisions as needed.
• Be available for periodic weekend and holiday telephonic decisions.
• Support compliance with regulatory standards such as CMS, NCQA, URAC, and third-party payers.
• Travel to scheduled meetings within the U.S.
• Assist in marketing presentations and client relationship management if required.
• Provide clinical support to staff conducting initial reviews.
• Understand performance measurement and provider engagement strategies.

Qualifications

Required:

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

Preferred:

• Experience in managed care
• Knowledge of claim coding and review processes
• Experience integrating clinical and financial data, and developing performance reports
• Strong interpersonal skills for telephonic collaboration with healthcare providers
• Ability to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range is $238,000 to $357,500 annually, based on experience and achievement metrics. Benefits include comprehensive health plans, incentive programs, stock options, and a 401(k). All employees must pass a drug test and comply with company policies.

UnitedHealth Group is committed to diversity, equity, and inclusion, actively working to reduce health disparities and promote equitable care. We are an equal opportunity employer and a drug-free workplace.

Additional Details

• Seniority level: Director
• Employment type: Full-time
• Job function: Healthcare Provider