Remote Spine Surgery Medical Director

Optum; United States; Remote; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contributions

Job summary

Optum, part of UnitedHealth Group, seeks a Medical Director to oversee medical review services, lead utilization management, and contribute to policy development. This role emphasizes accuracy, regulatory compliance, and collaboration with providers across networks.

You will work remotely from anywhere in the U.S., performing coverage reviews, peer discussions, and training participation, while guiding clinical standards and performance improvements.

Qualifications

• Current, active and unrestricted medical license.
• Board Certification in Orthopedic Surgery or Neurosurgery (ABMS or AOA).
• 5+ years clinical experience post residency in Orthopedic Surgery or Neurosurgery, including musculoskeletal/spine.
• Sound understanding of Evidence Based Medicine (EBM).
• Excellent computer skills and ability to learn new systems and software.

Responsibilities

• Conduct coverage reviews and render coverage determinations for musculoskeletal and spine services.
• Document clinical review findings and outcomes in accordance with policies and regulatory requirements.
• Coordinate coverage reviews with clinical staff and provide feedback to reviewers.
• Engage with requesting providers in peer-to-peer discussions.
• Interpret benefit language and policies during clinical coverage reviews.
• Participate in periodic clinical conferences/calls and internal performance reviews.
• Communicate with network and non-network providers to ensure accurate benefit determinations.
• Be available for periodic weekend/holiday telephonic coverage for urgent decisions.
• Participate in training on URAC, NCQA, Regulatory Compliance, HIPAA, and related topics.
• Support professional performance measurement and related discussions with providers.

Skills

Medical license

Board certification

Clinical experience 5+ years

Evidence Based Medicine

Computer skills

Job description

Optum, part of UnitedHealth Group, seeks a Medical Director to oversee medical review services, lead utilization management, and contribute to policy development. This role emphasizes accuracy, regulatory compliance, and collaboration with providers across networks.

You will work remotely from anywhere in the U.S., performing coverage reviews, peer discussions, and training participation, while guiding clinical standards and performance improvements.