Medical Director - Orthopedic Surgery - Remote

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

Job summary

A leading healthcare organization seeks a Medical Director specializing in Orthopedic Surgery to provide clinical support and oversight. This remote role involves conducting coverage reviews, collaborating with providers, and ensuring quality medical care. The position offers flexibility, competitive salary, and comprehensive benefits, emphasizing health equity.

Benefits

Comprehensive healthcare

Incentives

Stock purchase options

401k contributions

Qualifications

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

Responsibilities

• Conduct coverage reviews based on individual member plan benefits.
• Document clinical review findings per policies and regulatory requirements.
• Engage with providers in peer-to-peer discussions as needed.

Skills

Evidence-Based Medicine

Communication

Data Analysis

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

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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.

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 experiences, and manage healthcare costs.

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

The Medical Director collaborates with a multidisciplinary team and manages medical benefits, often involving primary care or specialist physicians. The primary responsibility is to ensure the provision of appropriate, cost-effective, and 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 individual member plan benefits and policies, render coverage determinations.
• Document clinical review findings, actions, and outcomes per policies and regulatory requirements.
• Engage with requesting 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, timely benefit determinations and educate them on benefit plans and policies.
• Collaborate with internal partners.
• Participate in holiday and call coverage rotation.
• Obtain additional licenses as needed.

You’ll be rewarded and recognized for your performance in an environment that challenges you, provides clear success criteria, and offers development opportunities.

Required Qualifications

• M.D. or D.O.
• Board certification in Orthopedic Surgery.
• Active unrestricted medical license.
• Ability to obtain additional licenses as needed.
• 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 coverage rotations.

Preferred Qualifications

• Experience in utilization and clinical coverage review.
• Excellent communication, facilitation, data analysis, and presentation skills.
• Innovative problem-solving skills.
• Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range is $238,000 to $357,500 annually, based on experience and performance. Benefits include comprehensive healthcare, incentives, stock purchase options, and 401k contributions. The role offers flexibility, growth, and a commitment to health equity.