Medical Director - Spine and Brain Surgery - Remote

Primary Responsibilities

• Reviews surgical and other professional claims for correct coding using clinical record
• Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
• Discusses cases and clinical coding 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

Required Qualifications

• Current, active, and fully unrestricted medical license
• Current board certification in Neurological Surgery through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)
• 5+ years of clinical experience with brain and spine surgeries post residency
• MS Office (MS Word, Excel, and Power Point)

Preferred Qualifications

• Experience working for a managed care organization
• Experience with professional claim coding / claim coding reviews
• Knowledge of claim coding resources and techniques
• Proficient computer skills and ability to learn to use clinical and claims software
• Proven excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel

Benefits

Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well.

Pay

Compensation for this specialty generally ranges from $248,500.00 to $373,000.00. 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).

Schedule

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy