Field Medical Director, MSK Surgery

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the Physician match reviewer for Hip/Knee/Shoulder Surgery cases that initially do not align with the applicable medical necessity guidelines.

• Evaluate additional imaging requests when a specialty review is mandated by providers, clients, or regulatory laws.

• Engage in discussions regarding determinations with requesting physicians or ordering providers through peer-to-peer calls within the specified regulatory timeframes.

• Offer clinical rationale for both standard and expedited appeals.

• Apply medical and clinical review guidelines and parameters to maintain consistency, appropriate utilization, and compliance with SBU policies/procedures, URAC, and NCQA standards.

• Serve as a resource for Initial Clinical Reviewers.

• Accurately document communications with medical office staff and physician providers in a timely manner.

• Support the Senior Medical Director in utilization management research, interpretation, guidelines, and/or system assistance.

• Engage in continuous training through the inter-rater reliability process.

• Frequently interact with leadership, management staff, physicians, and others when physician input is required.

⛳️ Requirements

• MD/DO/MBBS degree.

• At least five (5) years of experience in the practice of Medicine following residency.

• Active clinical practice within the past 2 years is strongly preferred.

• Current, unrestricted clinical license in medicine or the required specialty.

• Responsible for obtaining and maintaining medical licenses in your state of residence, as well as any licenses required for business purposes.

• Active Board Certification in Orthopedic Surgery.

• Excellent clinical, management, communication, and organizational abilities.

• Proficiency in computer usage.

• Not currently excluded or sanctioned by any state or federal healthcare program, including Medicare or Medicaid.

• No record of major disciplinary or legal actions by a state medical board.

• High-speed internet connection exceeding 10 Mbps at home.

• Capability for call center employees to connect directly to the home internet router.

• Submission of a government-issued photo ID and identity verification during the interview process.

• Completion of a comprehensive background check.

• In-person I-9 verification required.

• May be subject to drug screening prior to employment.

🏝️ Benefits

• Work/life balance.

• Flexible work arrangements.

• Autonomy to accomplish tasks.

• Supportive and inclusive work environment.

• Comprehensive benefits, including health insurance, for eligible employees.