Medical Director - Orthopaedic Surgery - Remote

Lensa; New York (NY); 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 role involves conducting coverage reviews, developing policies, and engaging with providers. Ideal candidates will have an MD or DO, board certification, and significant clinical experience. The position offers a competitive salary and flexible work environment.

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.
• Engage in peer-to-peer discussions with requesting providers.

Skills

Evidence-Based Medicine

Interpersonal Skills

Education

MD or DO

Board Certification in Orthopaedic Surgery

Tools

MS Office

Job description

Medical Director - Orthopaedic Surgery - Remote

This position reports to a team of medical directors and is responsible for overseeing the quality, effectiveness, and coordination of medical review services. The role includes performing Utilization Management reviews, directing staff activities, and participating in Quality Improvement programs.

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

Primary Responsibilities

1. Conduct coverage reviews based on member benefits and policies, focusing on musculoskeletal surgical procedures and related services.
2. Document clinical findings, actions, and outcomes in compliance with policies and regulations.
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 reviews.
6. Participate in clinical conferences and performance reviews.
7. Communicate with providers and internal teams to ensure accurate benefit determinations and educate providers on policies.
8. Provide periodic coverage rotation and be available for weekend and holiday coverage as needed.
9. Participate in training on compliance, confidentiality, HIPAA, and departmental policies.
10. Understand performance measurement and engage in discussions with providers and organizations.

Minimum Qualifications

• MD or DO with an 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 computer skills.
• Excellent interpersonal skills for remote communication 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.

The role offers a salary range of $238,000 to $357,500 annually, with benefits, incentives, and a flexible remote work environment within the U.S.