Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)As part of the Focus Claims Review team, the Medical Director provides leadership, organization, and direction for the claims review program. They are responsible for the overall quality, effectiveness and coordination of the medical services provided through OrthoNet. The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. In addition, the Medical Director may also be asked to assist in the direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. S/he will serve as a liaison between OrthoNet, physicians, and other medical service providers in selected situations primarily related to medical claim reviews. You'll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.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 Is available for occasional, periodic weekend and holiday as needed telephonic and remote computer expedited clinical decisions Supports compliance with regulatory agency standards and requirements (eg, CMS, NCQA, URAC, state / federal and third party payers) Ability to travel to scheduled company meetings and activities in US Ability to assist in marketing presentations to clients and ongoing relationship management activities with existing clients if requested to do so Provide Clinical support for staff that conduct initial reviews Good understanding of professional performance measurement and related possible discussions/interventions with selected providers/groups/organizations You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications: Current, active and fully unrestricted medical license Current board certification in an ABMS specialty 5+ years of clinical experience in Neurological Surgery post residency with Sub-Specialty training in complex brain and spinal cord conditions MS Office (MS Word, Excel, and Power Point) Excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnelPreferred Qualifications: Experience in managed care Experience with professional claim coding / claim coding reviews Experience with integration of clinical and financial data, development of utilization and performance reporting tools, and communication of performance data to physicians and other health care providers Knowledge of claim coding resources and techniques Proficient computer skills and ability to learn to use clinical and claims software To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $254,600 to $295,200. The salary range for Connecticut / Nevada residents is $254,600 to $295,200. The range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: Medical Director, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Neuro Spine Surgery FCR