Associate Medical Director, Orthopedic 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 your expertise to determine medical necessity, document decisions clearly, and communicate effectively with providers. This critical role involves applying evidence-based guidelines, meeting stringent quality parameters, and collaborating with a team of clinical and non-clinical professionals. The position offers a fast-paced environment where you will contribute to improving patient care at scale. Cohere Health is committed to fostering a supportive and growth-oriented environment for its employees.

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

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

• 1+ years of managed care utilization review experience
• Membership in national and/or regional specialty societies
• Licensure in AZ, FL, MN, ND, OR, or TX is highly desirable - you should be willing to obtain additional state licenses with Cohere's support

Benefits

• Health insurance
• 401k
• Bonus