Medical Director - Orthopedic Surgery - Remote

Lensa; Portland (OR); Remote; USD 238,000 - 358,000; Full time

Job summary

A leading healthcare organization seeks a Medical Director for Orthopedic Surgery, focusing on clinical review and collaboration with providers. This remote role offers flexibility and the chance to improve health outcomes. Candidates should have an M.D. or D.O. and board certification in Orthopedic Surgery. The position emphasizes communication and problem-solving skills, with a competitive salary and comprehensive benefits.

Benefits

Comprehensive benefits

Incentive programs

Stock options

401k contributions

Qualifications

• 5+ years of clinical practice experience post-residency.
• Active unrestricted license to practice medicine.

Responsibilities

• Conduct coverage reviews based on individual member plan benefits.
• Document clinical review findings and engage with providers.

Skills

Communication

Problem-solving

Data analysis

Education

M.D. or D.O.

Board certification in Orthopedic Surgery

Tools

MS Word

Outlook

Excel

Job description

Medical Director - Orthopedic Surgery - Remote

1 day 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.

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 and staff to establish, implement, support, and maintain clinical and operational processes related to benefit coverage, quality improvement, and cost-effectiveness of services for members. The role primarily focuses on clinical knowledge application in utilization management activities, especially pre-service benefit and coverage determinations or medical necessity, and on communication with physicians and other stakeholders.

The Medical Director collaborates with a multidisciplinary team and manages medical benefits, often involving the member’s primary care provider or specialist. The primary responsibility is to ensure the delivery 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

1. Conduct coverage reviews based on individual member plan benefits and policies, and render coverage determinations.
2. Document clinical review findings, actions, and outcomes in accordance with policies and regulatory requirements.
3. Engage with requesting providers as needed in peer-to-peer discussions.
4. Interpret existing benefit language and policies during clinical reviews.
5. Participate in daily clinical rounds as requested.
6. Communicate and collaborate with network and non-network providers to ensure accurate and timely benefit determinations, and educate providers on benefit plans and policies.
7. Collaborate with internal partners.
8. Participate in holiday and call coverage rotation.
9. Obtain additional licenses as needed.

You’ll be rewarded and recognized for your performance in an environment that challenges you and provides clear development pathways.

Required Qualifications

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

Preferred Qualifications

• Experience in utilization and clinical coverage review
• Excellent communication, facilitation, and interpersonal skills
• Data analysis and interpretation skills
• Problem-solving abilities
• Presentation skills for clinical and non-clinical audiences
• Remote work adherence to company policies

The salary range is $238,000 to $357,500 annually, with actual compensation based on experience, location, and other factors. Benefits include comprehensive packages, incentive programs, stock options, and 401k contributions. The application deadline is at least 2 business days from posting, subject to early removal if filled.

Our mission is to help people live healthier lives and improve health equity globally. We are committed to diversity, environmental sustainability, and equitable care, and are an Equal Employment Opportunity employer. Candidates must pass a drug test before employment begins.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider