Description

You will determine the medical appropriateness of orthopedic services by reviewing clinical information and applying evidence-based guidelines, conducting timely peer-to-peer discussions, and ensuring high-quality, timely reviews. This role is critical in a rapidly scaling Series B company impacting millions of patients.

Requirements

• Completed US-based residency in Orthopedic Surgery
• Board certification as MD or DO with unrestricted state license
• 5+ years clinical practice beyond residency/fellowship
• 1+ years managed care utilization review experience preferred
• Licensure in AZ, FL, MN, ND, OR, or TX highly desirable

Responsibilities

• Provide timely medical reviews meeting quality parameters
• Make clinical determinations based on evidence-based criteria
• Document decisions clearly in workflow tools
• Conduct timely peer-to-peer discussions with providers
• Support team clinical expertise and operational improvements