Medical Director - Orthopedic Surgery - Remote

Lensa; Dallas (TX); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director specializing in Orthopedic Surgery to provide physician support within Enterprise Clinical Services. This remote role involves conducting clinical reviews, collaborating with healthcare providers, and ensuring high-quality medical care delivery. Candidates must have an M.D. or D.O. with board certification, along with extensive clinical experience and proficiency in relevant software tools.

Benefits

Comprehensive health plans

Incentive programs

Stock purchase options

401(k) contributions

Qualifications

• At least 5 years of clinical practice post-residency.
• Proficiency in MS Word, Outlook, and Excel.

Responsibilities

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

Skills

Evidence-Based Medicine

Communication

Data Analysis

Presentation Skills

Education

M.D or D.O. with Board certification in Orthopedic Surgery

Active unrestricted medical license

Tools

MS Word

Outlook

Excel

Job description

Medical Director - Orthopedic Surgery - Remote

This role involves providing physician support within Enterprise Clinical Services, focusing on clinical review of service requests, benefit coverage determinations, and medical necessity assessments for members. The Medical Director collaborates with healthcare providers and internal teams to ensure the delivery of cost-effective, high-quality medical care, primarily in utilization management activities related to pre-service benefits and coverage decisions.

Primary Responsibilities:

1. Conduct coverage reviews based on member benefits and policies, and render determinations.
2. Document clinical findings and outcomes in compliance with policies and regulations.
3. Engage in peer-to-peer discussions with requesting providers.
4. Interpret benefit language and policies during reviews.
5. Participate in clinical rounds and collaborate with providers and internal teams to ensure accurate benefit determinations.
6. Participate in holiday and call coverage rotations.

Minimum Qualifications:

• M.D or D.O. with Board certification in Orthopedic Surgery.
• Active unrestricted medical license.
• At least 5 years of clinical practice post-residency.
• Understanding of Evidence-Based Medicine.
• Proficiency in MS Word, Outlook, and Excel.

Preferred Qualifications:

• Experience in utilization and clinical coverage review.
• Excellent communication, facilitation, data analysis, and presentation skills.

This position offers remote work flexibility within the U.S., with a salary range of $238,000 to $357,500 annually, based on experience and performance metrics. Benefits include comprehensive health plans, incentive programs, stock purchase options, and 401(k) contributions.