Medical Director Orthopedic Surgery
Core
Review clinical information to determine the medical appropriateness of musculoskeletal and orthopedic services using evidence-based guidelines.
Role type
Senior clinical reviewer (orthopedic surgery)
Builds
Prior authorization decisions and clinical determinations for health plan members and providers
Domain
Healthcare / Orthopedic Surgery / Utilization Review
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Orthopedic surgery residency completion, Board certification (MD/DO), unrestricted state medical license, 5+ years clinical practice, evidence-based guideline application, peer-to-peer clinical discussion, documentation in workflow tools
Preferred skills
Managed care utilization review experience, membership in national/regional specialty societies, licensure in AZ/FL/MN/ND/OR/TX
Technologies
Cohere workflow tools
Responsibilities
Provide timely medical reviews meeting quality parameters, conduct peer-to-peer discussions to clarify clinical information and explain review outcomes, document all communication and decision-making accurately, support team projects to build clinical expertise and efficiency, contribute to operational improvements for clinical review tasks
Seniority
Senior, hands-on IC