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 to oversee medical review services. This remote position requires an MD or DO with board certification and extensive clinical experience. The role involves conducting coverage reviews, coordinating with clinical staff, and ensuring compliance with policies. Join a diverse team committed to improving health outcomes and advancing health equity.

Benefits

Comprehensive health plans

Incentive programs

Stock options

401k

Qualifications

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

Responsibilities

• Conduct coverage reviews focusing on musculoskeletal surgical procedures.
• Coordinate coverage reviews with clinical staff and provide feedback.
• Participate in clinical conferences and performance reviews.

Skills

Communication

Interpersonal Skills

Evidence-Based Medicine

Education

MD or DO

Board Certification in Orthopaedic Surgery

Tools

MS Office

Job description

Medical Director - Orthopaedic Surgery - 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 will directly improve health outcomes by connecting people with care, pharmacy benefits, data, and resources. Our culture is guided by diversity and inclusion, with talented peers, comprehensive benefits, and career development opportunities. Join us to make an impact on communities and advance health equity globally. Come make a difference with us.

Position Overview: Responsible, as part of a team of medical directors, for the quality, effectiveness, and coordination of medical review services. Performs Utilization Management reviews, directs/coordinates staff activities, and participates in Quality Improvement programs. Provides oversight in developing and implementing policies, procedures, and clinical criteria for medical programs and services. May serve as a liaison between physicians and other providers.

Location: Remote work from anywhere in the U.S., with periodic weekend and holiday coverage as needed.

Primary Responsibilities

1. Conduct coverage reviews based on member benefits and policies, focusing on musculoskeletal surgical procedures and related services.
2. Document findings and actions in compliance with policies and regulatory standards (e.g., CMS, NCQA, URAC).
3. Coordinate coverage reviews with clinical staff and provide feedback.
4. Engage with providers in peer-to-peer discussions as needed.
5. Interpret benefit language and policies during reviews.
6. Participate in clinical conferences and performance reviews.
7. Communicate with providers and internal partners to ensure accurate benefit determinations and educate on policies.
8. Provide periodic telephonic and remote coverage decisions, including weekend and holiday shifts.
9. Participate in training on compliance, confidentiality, HIPAA, and department policies.
10. Maintain understanding of performance measurement and provider discussions.

Required Qualifications

• MD or DO with active, unrestricted 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 and communication skills, including with physicians and healthcare staff.

Preferred Qualifications

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

The salary range is $238,000 to $357,500 annually, based on experience and performance. Benefits include comprehensive health plans, incentive programs, stock options, and 401k. UnitedHealth Group is committed to diversity, equity, and inclusion, and is an Equal Opportunity Employer. Candidates must pass a drug test prior to employment.