Medical Director - Orthopaedic Surgery - Remote
Company: Optum
Location: Tempe
Posted on: May 12, 2025
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Job Description:
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.
Position in this function is responsible, in part, as a member of a
team of medical directors, for the overall quality, effectiveness
and coordination of the medical review services. Additionally,
performs Utilization Management reviews and directs/coordinates
aspects of the utilization review staff activities, and
participates in the Quality Improvement programs for the
company.
The Medical Director also provides/assists in the direction and
oversight in the development and implementation of policies,
procedures and clinical criteria for all medical programs and
services and may serve as a liaison between physicians, and other
medical service providers in selected situations.
You'll enjoy the flexibility to work remotely * from anywhere
within the U.S. as you take on some tough challenges. -
Primary Responsibilities:
Conduct coverage reviews based on individual member plan benefits
and national and proprietary coverage review policies, render
coverage determinations. The focus of the coverage reviews will be
various types of musculoskeletal surgical procedures and other
medical/surgical services for musculoskeletal procedures including
therapy
Document clinical review findings, actions and outcomes in
accordance with policies, and regulatory and accreditation
requirements. Supports compliance with regulatory agency standards
and requirements (e.g., CMS, NCQA, URAC, state / federal and
third-party payers)
Works with clinical staff to coordinate all the necessary coverage
reviews and provides feedback to staff who do portions of the
coverage reviews
Engage with requesting providers as needed in peer-to-peer
discussions
Be knowledgeable in interpreting existing benefit language and
policies in the process of clinical coverage reviews
Participates in periodic clinical conferences / calls and in
ongoing internal performance consistency reviews
Communicate and collaborate with network and non-network providers
in pursuit of accurate and timely benefit determinations for plan
participants while educating providers on benefit plans and medical
policy
Communicate and collaborate with other internal partners
Call coverage rotation. Is available for periodic weekend and
holiday coverage as needed for telephonic and remote computer
expedited clinical decisions
Participation in Training regarding URAC, NCQA, Regulatory
Compliance, Confidentiality, Conflict of Interest, HIPAA, and
department specific training as applicable
Good understanding of professional performance measurement and
related possible discussions/interventions with selected
providers/groups/organizations
You'll be rewarded and recognized for your performance in an
environment that will challenge you and give you clear direction on
what it takes to succeed in your role as well as provide
development for other roles you may be interested in.Required
Qualifications:
MD or DO with an active, unrestricted medical license
Current, active and unrestricted medical license
Willing to obtain additional licenses as needed
Board Certification in Orthopaedic Surgery
5+ years clinical practice experience post residency
Sound understanding of Evidence Based Medicine (EBM)
Proficient with MS Office (MS Word, Email, Excel, and Power
Point)
Proven excellent computer skills and ability to learn new systems
and software
Proven excellent interpersonal skills and the ability to work over
the telephone with other colleagues including physicians, nurses,
PTs, OTs and other similar personnel
Preferred Qualifications:
2+ years managed care, Quality Management experience and/or
administrative leadership experience
Experience in utilization and clinical coverage review
Clinical experience within the past 2 years
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy -
The salary range for this role is $238,000 to $357,500 per year.
Salary Range is defined as total cash compensation at target. The
actual range and pay mix of base and bonus is variable based upon
experience and metric achievement. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer
under applicable law and qualified applicants will receive
consideration for employment without regard to race, national
origin, religion, age, color, sex, sexual orientation, gender
identity, disability, or protected veteran status, or any other
characteristic protected by local, state, or federal laws, rules,
or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: Optum, Glendale , Medical Director - Orthopaedic Surgery - Remote, Executive , Tempe, Arizona
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