Medical Director - Orthopaedic Surgery - Remote

Lensa; Austin (TX); Remote; USD 238,000 - 358,000; Full time

Job summary

An established industry player is seeking a Medical Director specializing in Orthopaedic Surgery. This remote role offers the opportunity to lead a team of medical directors, ensuring quality and effectiveness in medical review services. You will engage in utilization management reviews, collaborate with healthcare providers, and develop clinical policies that enhance patient care. With a focus on health equity, this position allows you to make a significant impact on community health outcomes. Join a diverse and inclusive team dedicated to advancing healthcare for all.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• Active medical license required for practice.
• 5+ years of clinical experience post-residency is essential.
• Board Certification in Orthopaedic Surgery is preferred.

Responsibilities

• Conduct coverage reviews for musculoskeletal surgical procedures.
• Document clinical review findings and support compliance.
• Collaborate with providers for accurate benefit determinations.

Skills

Evidence Based Medicine (EBM)

Interpersonal Skills

MS Office

Clinical Review

Education

MD or DO with active medical license

Board Certification in Orthopaedic Surgery

5+ years clinical practice experience

Tools

MS Word

Excel

PowerPoint

Job description

Medical Director - Orthopaedic Surgery - Remote

Medical Director - Orthopaedic Surgery - Remote

1 day ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

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 is a global organization that delivers care, aided by technology to help millions of people 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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Position in this function is responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services. Additionally, performs Utilization Management reviews and directs/coordinates aspects of the utilization review staff activities, and participates in the Quality Improvement programs for the company.

The Medical Director also provides/assists in the direction and oversight in the development and implementation of policies, procedures and clinical criteria for all medical programs and services and may serve as a liaison between physicians, and other medical service providers in selected situations.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations. The focus of the coverage reviews will be various types of musculoskeletal surgical procedures and other medical/surgical services for musculoskeletal procedures including therapy
• Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements. Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
• Works with clinical staff to coordinate all the necessary coverage reviews and provides feedback to staff who do portions of the coverage reviews
• Engage with requesting providers as needed in peer-to-peer discussions
• Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews
• Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
• Communicate and collaborate with network and non-network providers in pursuit of accurate and timely benefit determinations for plan participants while educating providers on benefit plans and medical policy
• Communicate and collaborate with other internal partners
• Call coverage rotation. Is available for periodic weekend and holiday coverage as needed for telephonic and remote computer expedited clinical decisions
• Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
• Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations
  
  

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• MD or DO with an active, unrestricted medical license
• Current, active and unrestricted medical license
• Willing to obtain additional licenses as needed
• Board Certification in Orthopaedic Surgery
• 5+ years clinical practice experience post residency
• Sound understanding of Evidence Based Medicine (EBM)
• Proficient with MS Office (MS Word, Email, Excel, and Power Point)
• Proven excellent computer skills and ability to learn new systems and software
• Proven excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel
  
  

Preferred Qualifications

• 2+ years managed care, Quality Management experience and/or administrative leadership experience
• Experience in utilization and clinical coverage review
• Clinical experience within the past 2 years
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The salary range for this role is $238,000 to $357,500 per year. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

Referrals increase your chances of interviewing at Lensa by 2x

Get notified about new Medical Director jobs in Austin, TX.

Regional Medical Director (West Region) (70949)

Austin, TX $152,000.00-$229,000.00 1 month ago

Director of Research and Education Finance

Field Medical Director, Interventional Cardiology (Remote)

Manager, Medical Economics (Pop Health/Clinical Analytics) - REMOTE

Manager, Medical Economics (Marketplace) - REMOTE

Physician, Allergist (Hiring for Multiple Locations)

Emergency Medicine Telecommute Medical Review Stream Physician

Psychiatric Mental Health Nurse Practitioner - Texas, Part-Time 1099

Manager, Financial Performance Improvement

Austin, TX $109,000.00-$165,000.00 1 month ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.