Medical Director Spine Surgery

Skills

About the Role

You will deliver on Cohere's musculoskeletal and orthopedic programs by determining the medical appropriateness of services, reviewing clinical information, and applying evidence-based guidelines. Reporting to the Managing Medical Director, MSK Spine and Ortho, you'll be part of a review team including non-clinical intake specialists and nurses, playing a critical role at a rapidly scaling Series B company impacting millions of patients. You'll thrive in a fast-paced environment that rewards quick learning, hands-on work, comfort with ambiguity, and effective communication across diverse backgrounds and perspectives.

Requirements

• Completed US-based residency program in Orthopedic or Neurosurgery Surgery and fellowship program in Spine Surgery
• Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position
• 5+ years of clinical practice beyond residency/fellowship
• 1+ years of managed care utilization review experience
• Membership in national and/or regional specialty societies
• Licensure in AZ, GA, MS, NC, ND, OK, OR, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support

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, ensuring a member and provider can easily reference and understand your decision
• 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 to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere 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, and 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