Medical Director - Orthopaedic Surgery - Remote

Lensa; Philadelphia (Philadelphia County); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization seeks a Medical Director for Orthopaedic Surgery to oversee medical review services and ensure quality and effectiveness. This remote role involves conducting coverage reviews, collaborating with clinical staff, and maintaining compliance with regulatory standards. Ideal candidates will have an MD or DO, board certification, and extensive clinical experience. Join a diverse team committed to improving health outcomes on a global scale.

Benefits

Comprehensive health coverage

Incentive and recognition programs

Stock purchase options

401k contributions

Qualifications

• 5+ years clinical practice experience post-residency.
• Proficient with MS Office (Word, Email, Excel, PowerPoint).

Responsibilities

• Conduct coverage reviews based on individual member plan benefits.
• Document clinical review findings in accordance with policies.
• Communicate with network and non-network providers for benefit determinations.

Skills

Evidence-Based Medicine

Interpersonal Skills

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

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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 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

1. 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.
2. 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).
3. Work with clinical staff to coordinate all the necessary coverage reviews and provide feedback to staff who do portions of the coverage reviews.
4. Engage with requesting providers as needed in peer-to-peer discussions.
5. Be knowledgeable in interpreting existing benefit language and policies in the process of clinical coverage reviews.
6. Participate in periodic clinical conferences / calls and in ongoing internal performance consistency reviews.
7. 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.
8. Communicate and collaborate with other internal partners.
9. Call coverage rotation. Be available for periodic weekend and holiday coverage as needed for telephonic and remote computer expedited clinical decisions.
10. Participate in training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department-specific training as applicable.
11. Maintain a good understanding of professional performance measurement and related discussions/interventions with 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 (Word, Email, Excel, PowerPoint)
• Proven excellent computer skills and ability to learn new systems and software
• Excellent interpersonal skills and ability to work remotely with physicians, nurses, PTs, OTs, and other personnel

Preferred Qualifications

• 2+ years managed care, Quality Management, and/or administrative leadership experience
• Experience in utilization and clinical coverage review
• Clinical experience within the past 2 years
• Adherence to UnitedHealth Group’s Telecommuter Policy for remote employees

The salary range for this role is $238,000 to $357,500 per year, based on experience, certifications, and performance metrics. Benefits include comprehensive health coverage, incentive and recognition programs, stock purchase options, and 401k contributions. We are committed to diversity, equity, and inclusion, and to mitigating our environmental impact. UnitedHealth Group is an Equal Opportunity Employer and a drug-free workplace, requiring a drug test prior to employment.