Physician / Surgery - Orthopedics / California / Permanent / Associate Medical Director - Ortho[...]

eviCore healthcare; San Francisco (CA); Remote; USD 150,000 - 200,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated medical professional to provide expert reviews and evaluations of medical necessity. This role offers a predictable work schedule with both full and part-time options, ensuring a healthy work-life balance. Enjoy the flexibility of remote work opportunities, comprehensive health benefits, and a supportive environment focused on employee growth. Join a team committed to making a positive impact on healthcare while enjoying a rewarding career with competitive compensation and numerous benefits.

Benefits

Flexible Scheduling

Remote Work Opportunities

Paid Time Off (PTO)

Paid Holidays

Continuing Medical Education (CME)

Education Assistance

Health Benefits

Volunteer Days

Growth Opportunities

401k Plan with Company Match

Qualifications

• Must have an active U.S. state medical license.
• Minimum of 5 years of clinical experience beyond residency.

Responsibilities

• Provides expert medical review for service evaluations.
• Engages in peer-to-peer discussions with physicians.

Skills

Medical Review

Clinical Experience

Peer-to-Peer Discussions

Knowledge of URAC and NCQA Standards

Familiarity with Automated Processes

Education

M.D. or D.O.

Board Certification in Surgery - Orthopedics

Tools

Computer Applications

Job description

Position Overview

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria within a U.S. state or territory.

Reviews appeals for denied services based on current medical experience or knowledge, following appeal policies if delegated.

Engages in peer-to-peer discussions with referring physicians to clarify clinical information and review outcomes.

Maintains necessary credentials and promptly reports any adverse actions related to medical licenses or board certifications to eviCore.

Participates in strategic planning and evaluation of the Care Management processes.

Qualifications

• Must be an M.D. or D.O. with an active, current U.S. state medical license.
• Board certified in Surgery - Orthopedics, recognized by the American Board of Medical Specialties (ABMS).
• Recent practice experience in direct patient care within the past 18 months.
• Minimum of 5 years of clinical experience beyond residency/fellowship.
• Knowledge of applicable state and federal laws, URAC, and NCQA standards is a plus.
• Familiarity with automated processes, computer applications, and systems is required.

Work Environment & Benefits

No nights, weekends, or on-call responsibilities.

Predictable work schedule with full and part-time options.

Salaried position with benefits, including flexible scheduling, remote work opportunities, PTO, paid holidays, CME, education assistance, health benefits, volunteer days, growth opportunities, and a 401k plan with company match.

Company Commitment

eviCore healthcare is dedicated to positive impacts on healthcare and our employees. We promote diversity and are an Equal Opportunity Employer. Applicants must pass a drug test and background check.