Remote Medical Director, Spine & Brain Surgery Claims

Optum; Nashville (TN); Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Remote work

Incentive and recognition programs

Equity stock purchase

401(k) contribution

Telecommuter policy

Job summary

Optum is seeking a Medical Director to provide leadership for the Focus Claims Review program. You will oversee the medical review of claims, engage in provider discussions, and guide policy development to support compliant clinical criteria.

This role offers remote work from anywhere in the U.S. and requires board certification in Neurological Surgery with 5+ years of brain and spine surgery experience. Strong communication and regulatory knowledge are essential.

Qualifications

• Active, unrestricted medical license in the US.
• Board certification in Neurological Surgery (ABMS or AOA).
• 5+ years of clinical brain and spine surgery experience post residency.
• Proficient with MS Office tools.

Responsibilities

• Oversee medical claim review program quality and coordination.
• Lead provider discussions and appeals related to medical claims.
• Assist in policy/procedure development and clinical criteria.
• Serve as liaison among Optum, physicians, and other providers.
• Ensure compliance with regulatory standards and payer requirements.
• Supports compliance with CMS, NCQA, URAC, and payer requirements.

Skills

Medical license

Neurosurgery experience

Clinical reasoning

Education

Board certification in Neurological Surgery (ABMS/AOA)

Tools

MS Office (Word, Excel, PowerPoint)

Job description

Optum is seeking a Medical Director to provide leadership for the Focus Claims Review program. You will oversee the medical review of claims, engage in provider discussions, and guide policy development to support compliant clinical criteria.

This role offers remote work from anywhere in the U.S. and requires board certification in Neurological Surgery with 5+ years of brain and spine surgery experience. Strong communication and regulatory knowledge are essential.