Medical Director - Orthopaedic Surgery - Remote

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

Job summary

A leading healthcare organization is seeking a Medical Director specializing in Orthopaedic Surgery. This remote position involves overseeing medical review services, conducting coverage reviews, and collaborating with clinical staff to ensure quality care. Ideal candidates will have extensive clinical experience and board certification. Join a team committed to improving health outcomes and advancing health equity.

Benefits

Comprehensive health plans

Incentive programs

Stock purchase options

401k plan

Qualifications

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

Responsibilities

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

Skills

Evidence-Based Medicine

MS Office

Education

MD or DO

Board certification in Orthopaedic Surgery

Job description

Medical Director - Orthopaedic Surgery - Remote

19 hours ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

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, performs Utilization Management reviews, directs/coordinates activities of the utilization review staff, and participates in Quality Improvement programs.

The Medical Director also provides guidance in developing and implementing policies, procedures, and clinical criteria for all medical programs and services, and may serve as a liaison between physicians and other medical service providers.

Location

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

Primary Responsibilities

• Conduct coverage reviews based on member benefits and policies, focusing on musculoskeletal surgical procedures and related services.
• Document clinical review findings in compliance with policies and regulatory standards.
• 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 reviews.
• Participate in clinical conferences and internal review processes.
• Collaborate with providers and internal teams to ensure accurate benefit determinations and educate providers on policies.
• Provide periodic coverage rotation and be available for weekend and holiday remote coverage.
• Participate in training on compliance, confidentiality, HIPAA, and departmental protocols.
• Understand performance measurement and engage in provider discussions as appropriate.

Qualifications

• MD or DO with an active, unrestricted license.
• Board certification in Orthopaedic Surgery.
• 5+ years of clinical practice post-residency.
• Knowledge of Evidence-Based Medicine.
• Proficiency in MS Office and computer skills.

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 & Benefits

The salary range is $238,000 to $357,500 annually, based on experience and performance. Benefits include comprehensive health plans, incentive programs, stock purchase options, and a 401k plan. Additional benefits are available based on eligibility.

Our Commitment

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