Medical Director Spine Surgery
Core
Review clinical information to determine the medical appropriateness of musculoskeletal and orthopedic services using evidence-based guidelines.
Role type
Senior clinical utilization review physician (spine surgery)
Builds
Clinical determinations for prior authorization and payment accuracy
Domain
Healthcare / Orthopedic Spine Surgery / Managed Care Utilization Review
Required skills
Orthopedic or Neurosurgery residency, Spine Surgery fellowship, Board certification (MD/DO), State medical license, 5+ years clinical practice, Managed care utilization review experience, Peer-to-peer clinical discussion
Preferred skills
Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX
Technologies
Cohere workflow tools
Responsibilities
Provide timely medical reviews meeting quality parameters, Conduct peer-to-peer discussions with treating providers, Document decision-making accurately in workflow tools, Support team clinical expertise and operational improvements
Seniority
Senior, hands-on IC