Clinical Review Medical Director - Orthopedic Surgery

Clinical Advocacy & Support has an unrelenting focus on the customer journey and ensuring we exceed expectations as we deliver clinical coverage and medical claims reviews. Our role is to empower providers and members with the tools and information needed to improve health outcomes, reduce variation in care, deliver seamless experience, and manage health care costs.The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package) , and on communication regarding this process with both network and non-network physicians, as well as other Enterprise Clinical Services.You'll enjoy the flexibility towork 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 Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements 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 Participate in daily clinical rounds as requestedRequired Qualifications: M.D or D.O. Board certification inOrthopedic Surgery Active unrestricted license to practice medicine 5+ years of clinical practice experience after completing residency training*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.Compensation for this specialty generally ranges from $248,500 - $373,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives.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.