Medical Director - Orthopedic Surgery

Job Summary

A company is looking for a Medical Claims Review Medical Director specializing in Neurosurgery or Orthopedic Surgery, working remotely.

Key Responsibilities

• Conduct coverage reviews and render coverage determinations based on member plan benefits
• Document clinical review findings and engage in peer-to-peer discussions with providers
• Communicate and collaborate with network and non-network providers for accurate benefit determinations

Required Qualifications

• M.D. or D.O. with an active unrestricted medical license
• Board certification in Orthopedic Surgery or Neurosurgery
• 5+ years of clinical practice experience post-residency
• Proven understanding of Evidence Based Medicine (EBM)
• Demonstrated proficiency in using MS Word, Outlook, and Excel