Medical Director Orthopedic Surgery

Skills

About the Role

You will use your expertise in Orthopedic Surgery to support Cohere's musculoskeletal and orthopedic programs by determining the medical appropriateness of services. You'll review clinical information, apply evidence-based guidelines, and provide timely, high-quality medical reviews. Reporting to the Managing Medical Director, Orthopedic Surgery, you'll work alongside a review team of non-clinical intake specialists and nurses in a fast-paced environment that requires quick learning, hands-on problem solving, and clear communication with people of different backgrounds and perspectives. You'll document your decisions clearly using Cohere's workflow tools and templates, conduct peer-to-peer discussions with treating providers, and support broader team projects and operational improvements.

Requirements

• Completed US-based residency program in Orthopedic Surgery
• Board certification by appropriate specialty board as an MD or DO with a current unrestricted state license to practice medicine
• 5+ years of clinical practice beyond residency/fellowship
• 1+ years of managed care utilization review experience preferred
• Membership in national and/or regional specialty societies preferred
• Licensure in AZ, FL, MN, ND, OR, or TX is highly desirable

Responsibilities

• Provide timely medical reviews that meet Cohere's stringent quality parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
• Clearly and accurately document all communication and decision-making in Cohere workflow tools
• Use correct templates for documenting decisions during case review
• Meet the appropriate turn-around times for clinical reviews
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and explain review outcome decisions
• Demonstrate the highest level of professionalism, accountability, and service in interactions with teammates and providers
• Support projects specific to building the team's clinical expertise and efficiency, as delegated
• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated

Benefits

• Fully remote opportunity with about 5% travel
• Medical, dental, vision, life, disability insurance
• Employee Assistance Program
• 401K retirement plan with company match
• Flexible spending and health savings account
• Flex Time Off + company holidays
• Up to 14 weeks of paid parental leave
• Pet insurance