Associate Medical Director – Orthopedic Surgery
| Company | Elevance Health |
|---|---|
| Location | Las Vegas, NV, USA, Seattle, WA, USA, Indianapolis, IN, USA, Louisville, KY, USA, Nashville, TN, USA, Newport Beach, CA, USA, Washington, DC, USA, Miami, FL, USA, Durham, NC, USA, Chicago, IL, USA, St. Louis, MO, USA, Mason, OH, USA, Hanover, MD, USA, Walnut Creek, CA, USA, Latham, NY, USA, Denver, CO, USA, Atlanta, GA, USA, Grand Prairie, TX, USA, Mendota Heights, MN, USA |
| Salary | $223822 – $424095 |
| Type | Full-Time |
| Degrees | JD |
| Experience Level | Mid Level, Senior |
Requirements
- Requires MD or DO and Board certification by the American Board of Orthopedic Surgery or American Osteopathic Board of Orthopedic Surgery.
- Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s).
- Experience performing standard orthopedic procedures independently.
Responsibilities
- Determines the medical necessity of requests using clinical criteria.
- Performs physician-level case review of musculoskeletal utilization requests.
- Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate sites of service.
- Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments.
- Performs first level provider appeals of coverage decisions.
- Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management.
- Participates in physician team meetings.
- Participates in groups that develop, revise and enhance clinical appropriateness guidelines.
Preferred Qualifications
- Minimum of 3 years of clinical practice experience past fellowship training preferred.
- Extensive orthopedic surgery experience preferred.
- Experience with utilization management, especially with CMS guidelines preferred.