Orthopedic Spine Medical Director OrthoNet Telecommute

UnitedHealth Group
Published
May 2, 2021
Location
Jacksonville, FL
Category
Job Type

Description

Responsible, in part, as a member of a team of medical directors, for the overall quality, effectiveness and coordination of the medical review services provided through OrthoNet.  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 will participate in the monitoring of patient care progress, treating physician medical decision making in the context of utilization management and provider appeals

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.  S/he may serve as a liaison between OrthoNet, physicians, and other medical service providers in selected situations  

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges

Primary Responsibilities:

  • Performs utilization management reviews for various types of musculoskeletal and other medical/surgical services which may include PT OT ST, home health care, SNF, LTAC and acute inpatient rehabilitation services
  • Works with OrthoNet clinical staff to coordinate all the necessary UM processes and provides feedback to OrthoNet staff who do portions of the UM reviews
  • Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
  • Discusses cases and clinical situations with treating providers telephonically during scheduled hours
  • Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
  • Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions
  • Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
  • Provide Clinical support for staff that conduct initial reviews; which could include consolations with NP’s or CM’s
  • 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:

  • Current, active and fully unrestricted Medical license in state of residence
  • Current Board Certification in an ABMS or AOBMS specialty in orthopedic surgery
  • 5+ years clinical experience post residency in musculoskeletal/ spine surgery
  • Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel
  • Proficiency with computer skills and ability to learn new systems and software
  • Excellent project management skills
  • Solid data analysis and interpretation skills; ability to focus on key metrics
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders.

Preferred Qualifications:

  • Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers
  • Board certification in ABSS (American Board of Spine Surgery) strongly preferred

Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary/hourly range for Colorado residents is $110,200 to $211,700 (add additional reference for sales and physicians). Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Orthopedic, Spine, Medical Director, Telecommute, Surgery, Surgeon

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