Medical Director - Orthopaedic Surgery - Remote

Lensa; Tampa (FL); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director for Orthopaedic Surgery to oversee quality and coordination of medical review services. This remote role involves conducting coverage reviews, engaging with providers, and ensuring compliance with healthcare policies. The ideal candidate will have a medical degree, board certification, and extensive clinical experience. Join a team dedicated to improving health outcomes and promoting health equity.

Benefits

Comprehensive Benefits Package

Incentive Programs

Stock Options

401k

Qualifications

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

Responsibilities

• Conduct coverage reviews for musculoskeletal surgeries.
• Document findings in compliance with policies.
• Engage with providers for peer-to-peer discussions.

Skills

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. Your work will directly improve health outcomes by connecting people with care, pharmacy benefits, data, and resources. Our culture values diversity and inclusion, talent, benefits, and career growth. Join us to make an impact on communities and advance health equity globally. Caring. Connecting. Growing together.

This position, as part of a team of medical directors, oversees the quality, effectiveness, and coordination of medical review services. Responsibilities include performing Utilization Management reviews, directing staff activities, and participating in Quality Improvement programs.

The Medical Director also helps develop and implement policies, procedures, and clinical criteria for medical programs and may liaise with physicians and other providers.

You can work remotely from anywhere in the U.S., tackling challenging projects.

Primary Responsibilities

• Conduct coverage reviews based on member benefits and policies, focusing on musculoskeletal surgeries and related services.
• Document findings and outcomes in compliance with policies and regulations (e.g., CMS, NCQA, URAC).
• Coordinate reviews with clinical staff and provide feedback.
• Engage with providers for peer-to-peer discussions as needed.
• Interpret benefit language and policies during reviews.
• Participate in clinical conferences, internal reviews, and training on compliance and confidentiality.
• Communicate with providers and internal teams to ensure accurate benefit determinations and educate providers on policies.
• Be available for periodic weekend and holiday coverage for remote clinical decisions.

Required 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 ability to learn new systems.
• 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 salary range is $238,000 to $357,500 annually, based on experience and performance. Benefits include comprehensive packages, incentive programs, stock options, and 401k. UnitedHealth Group promotes health equity and is committed to diversity, inclusion, and equal opportunity employment. Candidates must pass a drug test before employment.