Remote Associate Medical Director, Orthopedic Spine Surgery

Summary

Join Cohere Health, a rapidly growing clinical intelligence company, as an Orthopedic Surgeon to conduct medical appropriateness reviews for musculoskeletal and orthopedic programs. You will utilize evidence-based guidelines and clinical expertise to make timely and accurate clinical determinations. This critical role involves collaborating with providers, documenting decisions clearly, and meeting stringent quality parameters. The position requires a US-based orthopedic surgery residency, board certification, and 5+ years of clinical practice beyond residency. Cohere Health offers a competitive salary, comprehensive benefits, and a fast-paced, supportive environment.

Requirements

• Completed US-based residency program in Orthopedic 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
• Utilization Management experience

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

Preferred Qualifications

• Fellowship program in Spine Surgery
• 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

Benefits

• Health insurance
• 401k
• Bonus