Medical Director, Operations, Ortho/Spine

Summary

Join Cohere Health as a Medical Director to lead a team of Associate Medical Directors specializing in Orthopedic and Spine Surgery. This remote, full-time position involves overseeing clinical reviews, managing a remote workforce, developing standard operating procedures, and collaborating with various teams. You will play a key role in a rapidly growing company impacting millions of patients. The ideal candidate possesses strong leadership, communication, and clinical expertise in orthopedic and spine surgery, along with experience in managed care. This is a permanent, remote position offering a competitive salary and benefits package.

Requirements

• Able to multitask and manage tasks to completion on a timely basis and in an organized fashion
• Excels in a matrix organization
• Strong interpersonal, oral and written communication skills
• Ability to work remotely and meet telephonically and/or via video with clinical colleagues and other personnel
• Proficient in using a Mac laptop computer and the Google Workspace of applications
• Comfortable with technology - willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Detail-oriented, flexible, and able to work autonomously with little supervision
• Completed US-based residency program in Orthopedic Surgery; Spine surgery fellowship training or extensive clinical experience required
• Board certification as an MD or DO with a current unrestricted state license to practice medicine - must maintain necessary credentials to retain the position
• 5+ years of clinical practice beyond residency/fellowship

Responsibilities

• Lead a team of Orthopedic Surgery and Spine Surgery Associate Medical Directors responsible for prior authorization clinical reviews and peer-to-peer discussions
• Inspire and motivate team members to perform at their best
• Demonstrated ability to oversee and collaborate with staff
• Proven experience managing a remote workforce and operating efficiently in a virtual environment
• Identify potential problems and points of friction and working to find solutions in order to maximize efficiency and revenue
• Develop and document standard operating procedures
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
• Support the clinical guidelines team in developing and reviewing the company’s clinical decision guidelines in conjunction with client guidelines and directives
• Perform timely review of Medical Coverage Policies for our clients
• Participate in internal and external audits of physicians and nurses
• Participate in recruiting of AMDs as business needs grow
• Participate in developing and implementing of physician training
• Support MSK strategy team focused on Spine strategy. This includes new strategy around site of service, level of care, temporary codes, G&A alignment, policy work and other areas such as reviewer efficiency enhancements, client facing meetings, etc
• Help to promote and maintain professional relationships or partnerships with Spine medical specialty societies, specifically NASS
• Be willing to travel as needed for client facing meetings or strategic onsite meetings
• Maintain awareness of any changes in the literature, standard of care, or regulatory guidance impacting the criteria by which the company reviews service requests
• Maintain necessary credentials and immediately informs Cohere of any adverse actions relating to medical licenses and/or board certifications
• Perform other duties as delegated

Preferred Qualifications

• 2+ years of managed care utilization review experience
• 1+ years of direct supervision/management experience, preferably in a utilization management or payor organization
• Experience with clinical decision-making criteria sets (i.e., Milliman, InterQual)
• 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
• Remote work