Medical Director - Orthopaedic Surgery - Remote

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

Job summary

A leading healthcare organization is seeking a Medical Director for Orthopaedic Surgery. This remote role involves overseeing medical review services, conducting coverage reviews, and developing clinical policies. Ideal candidates will have an MD or DO, board certification, and significant clinical experience. The position offers competitive compensation and comprehensive benefits while promoting health equity.

Benefits

Comprehensive health plans

Incentive programs

Stock purchase options

401k contributions

Qualifications

• At least 5 years of clinical practice post-residency.
• Knowledge of Evidence-Based Medicine.

Responsibilities

• Conduct coverage reviews focusing on musculoskeletal surgical procedures.
• Document clinical findings in compliance with policies.
• Engage with providers in peer-to-peer discussions.

Skills

Evidence-Based Medicine

Interpersonal Skills

Remote Communication

Education

MD or DO with an active, unrestricted medical license

Board certification in Orthopaedic Surgery

Tools

MS Office

Job description

Medical Director - Orthopaedic Surgery - Remote

Be among the first 25 applicants.

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. Your work will directly improve health outcomes by connecting people with care, pharmacy benefits, data, and resources. We foster a culture 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 and help advance health equity globally. Start Caring. Connecting. Growing together.

The position involves overseeing the quality, effectiveness, and coordination of medical review services as part of a team of medical directors. Responsibilities include performing Utilization Management reviews, directing staff activities, and participating in Quality Improvement programs.

The Medical Director also develops and implements policies, procedures, and clinical criteria for medical programs and services, and may serve as a liaison between physicians and other medical service providers.

Enjoy the flexibility to work remotely from anywhere within the U.S. while tackling challenging tasks.

Primary Responsibilities

• Conduct coverage reviews based on member benefits and policies, focusing on musculoskeletal surgical procedures and related services.
• Document clinical findings, actions, and outcomes in compliance with policies and regulatory standards (e.g., CMS, NCQA, URAC).
• Coordinate coverage reviews with clinical staff and provide feedback.
• Engage with providers in peer-to-peer discussions as needed.
• Interpret benefit language and policies during clinical reviews.
• Participate in clinical conferences, internal reviews, and training on compliance and confidentiality.
• Communicate with providers and internal teams to ensure accurate benefit determinations and educate on policies.
• Be available for periodic weekend and holiday coverage for telephonic and remote decisions.
• Adhere to organizational policies and participate in relevant training.
• Maintain understanding of performance measurement and provider interventions.

You will be recognized for your performance in a challenging environment that offers clear success pathways and development opportunities.

Required Qualifications

• MD or DO with an active, unrestricted medical license.
• Board certification in Orthopaedic Surgery.
• At least 5 years of clinical practice post-residency.
• Knowledge of Evidence-Based Medicine.
• Proficiency in MS Office and ability to learn new systems.
• Excellent interpersonal skills for remote communication with healthcare professionals.

Preferred Qualifications

• Over 2 years of managed care, Quality Management, or administrative leadership experience.
• Experience in utilization and clinical coverage review within the past 2 years.

The salary range is $238,000 to $357,500 annually, with actual compensation based on experience and metrics. Benefits include comprehensive health plans, incentive programs, stock purchase options, and 401k contributions. We are committed to health equity and diversity, ensuring equal opportunity employment and a drug-free workplace.