Medical Director - Orthopaedic Surgery - Remote

Lensa; Indianapolis (IN); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director in Orthopaedic Surgery to oversee medical review services and ensure quality care. This remote role involves conducting coverage reviews, collaborating with providers, and participating in quality improvement programs. Candidates should possess an MD or DO, board certification, and substantial clinical experience.

Benefits

Comprehensive health plans

Incentive programs

Stock purchase options

401(k)

Qualifications

• At least 5 years of clinical practice post-residency.
• 2+ years in managed care, Quality Management, or administrative leadership preferred.
• Recent clinical experience within the past 2 years preferred.

Responsibilities

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

Skills

Evidence-Based Medicine (EBM)

Interpersonal skills

Proficiency in MS Office Suite

Education

MD or DO with an active, unrestricted medical license

Board Certification in Orthopaedic Surgery

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 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 Overview

This role is responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness, and coordination of medical review services. Additionally, it involves performing Utilization Management reviews, directing/coordination of the utilization review staff activities, and participating in Quality Improvement programs for the company.

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

Remote Work Flexibility

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

Primary Responsibilities

1. Conduct coverage reviews based on member plan benefits and policies, make coverage determinations focusing on musculoskeletal surgical procedures and related medical services.
2. Document clinical review findings, actions, and outcomes in compliance with policies and regulatory standards (e.g., CMS, NCQA, URAC).
3. Coordinate coverage reviews with clinical staff and provide feedback.
4. Engage in peer-to-peer discussions with requesting providers as needed.
5. Interpret benefit language and policies during clinical reviews.
6. Participate in clinical conferences, internal performance reviews, and ongoing training.
7. Collaborate with network and non-network providers to ensure accurate and timely benefit determinations and educate them on policies.
8. Provide coverage rotation, including periodic weekend and holiday coverage for telephonic and remote decisions.
9. Participate in training related to compliance, confidentiality, HIPAA, and department-specific protocols.
10. Maintain a good understanding of performance measurement and provider interactions.

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.
• Understanding of Evidence-Based Medicine (EBM).
• Proficiency in MS Office Suite.
• Excellent computer, interpersonal skills, and ability to work remotely with healthcare professionals.

Preferred Qualifications

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

Compensation and Benefits

The salary range is $238,000 to $357,500 annually, with total cash compensation at target. Benefits include comprehensive health plans, incentive programs, stock purchase options, and a 401(k). Benefits are subject to eligibility.

Commitment to Diversity

UnitedHealth Group is committed to diversity, equity, and inclusion, striving to mitigate health disparities and promote equitable care. We are an Equal Employment Opportunity employer and a drug-free workplace requiring pre-employment drug testing.