Medical Director - Orthopedic Surgery - Remote

Lensa; Baltimore (MD); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director for Orthopedic Surgery. This remote role involves clinical reviews, collaboration with providers, and ensuring high-quality medical care. Candidates must have an M.D. or D.O. and board certification in Orthopedic Surgery. The position offers a competitive salary and comprehensive benefits.

Benefits

Comprehensive benefits

Incentive programs

Stock options

401k contributions

Qualifications

• 5+ years of clinical practice post-residency.
• Active unrestricted medical license required.

Responsibilities

• Conduct coverage reviews based on member benefits and policies.
• Document clinical review findings and outcomes.
• Engage with providers in peer-to-peer discussions.

Skills

Evidence-Based Medicine

Communication

Problem-Solving

Education

M.D. or D.O.

Board certification in Orthopedic Surgery

Tools

MS Word

Outlook

Excel

Job description

Medical Director - Orthopedic Surgery - Remote

2 days ago Be among the first 25 applicants

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.

Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage healthcare costs.

The Medical Director provides physician support to Enterprise Clinical Services operations, responsible for the initial clinical review of service requests. The Medical Director collaborates with leadership to establish, implement, and maintain clinical and operational processes related to benefit coverage, quality improvement, and cost-effectiveness of services. The activities focus on utilization management, particularly pre-service benefit and coverage determinations or medical necessity assessments, and communication with network and non-network physicians.

The Medical Director works with a multidisciplinary team and manages medical benefits, often involving primary care or specialist physicians. The primary responsibility is to ensure the delivery of appropriate, cost-effective, and high-quality medical care to members.

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, render determinations
• Document clinical review findings, actions, and outcomes in compliance with policies and regulations
• Engage with providers in peer-to-peer discussions as needed
• Interpret benefit language and policies during clinical reviews
• Participate in daily clinical rounds as requested
• Communicate and collaborate with providers to ensure accurate benefit determinations and educate on benefit plans and policies
• Coordinate with internal partners
• Participate in holiday and call coverage rotation
• Obtain additional licenses as required

We offer a challenging environment with clear performance expectations and opportunities for career development.

Required Qualifications

• M.D. or D.O.
• Board certification in Orthopedic Surgery
• Active unrestricted medical license
• 5+ years of clinical practice post-residency
• Understanding of Evidence-Based Medicine (EBM)
• Proficiency in MS Word, Outlook, and Excel
• Ability to participate in holiday and call rotations

Preferred Qualifications

• Experience in utilization and clinical coverage review
• Excellent communication and facilitation skills
• Data analysis and interpretation skills
• Problem-solving abilities
• Strong presentation skills for diverse audiences
• Remote work adherence to company policies

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 contributions. We are committed to diversity, equity, and inclusion, and an equal opportunity employer.