Remote Medical Director: Spine Surgery & Orthopedics

ISHE; Minneapolis (MN); Hybrid; USD 224,000 - 373,000; Full time

Job summary

UnitedHealth Group’s Optum division is seeking a Medical Director to oversee medical review services. The role focuses on utilization review, policy implementation, and collaboration with physicians and providers. Remote work within the U.S.

is supported, with potential weekend coverage. The compensation ranges reflect lucrative total cash compensation tied to performance and location. The role requires board certification, extensive orthopedic/neurosurgery experience, and strong EBM

Qualifications

• Current, active and unrestricted medical license.
• Board Certification in Orthopedic Surgery or Neurosurgery (ABMS/AOA).
• 5+ years clinical experience post residency in Orthopedic Surgery or Neurosurgery.
• Sound understanding of Evidence Based Medicine (EBM).
• Proficient with MS Office (MS Word, Email, Excel, and Power Point).
• Willing to obtain additional licenses as needed.

Responsibilities

• Conduct coverage reviews based on member plan benefits and policies, render coverage determinations.
• Document clinical review findings and outcomes in accordance with policies and accreditation requirements.
• Coordinate coverage reviews with clinical staff and provide feedback to staff.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies in clinical coverage reviews.
• Participate in clinical conferences and internal performance reviews.
• Collaborate with network and non-network providers for accurate benefit determinations.
• Manage coverage rotation and weekend/holiday coverage as needed for telephonic/remote decisions.
• Participate in URAC, NCQA, Regulatory Compliance, Confidentiality, and HIPAA training.

Skills

Interpersonal skills

MS Office proficiency

Excellent computer skills

Telephone communication

Tools

MS Office

Job description

UnitedHealth Group’s Optum division is seeking a Medical Director to oversee medical review services. The role focuses on utilization review, policy implementation, and collaboration with physicians and providers. Remote work within the U.S.

is supported, with potential weekend coverage. The compensation ranges reflect lucrative total cash compensation tied to performance and location. The role requires board certification, extensive orthopedic/neurosurgery experience, and strong EBM