Associate Medical Director - Orthopedic Surgery

Anticipated End Date:

2025-07-11

Position Title:

Associate Medical Director - Orthopedic Surgery

Job Description:

Clinical Operations Associate Medical Director

Orthopedic Surgery

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Work schedule:  Monday – Friday 8:00am to 5:00pm depending on your zone.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
 

The Clinical Operations Associate Medical Director - Orthopedic Surgery is responsible for performing pre-authorizations and providing quality improvement solutions for musculoskeletal procedures involving the joints.

How you will make an impact:

• Determines the medical necessity of requests using clinical criteria.

• Performs physician-level case review of musculoskeletal utilization requests.

• Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate sites of service.

• Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments.

• Performs first level provider appeals of coverage decisions.

• Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management.

• Participates in physician team meetings.

• Participates in groups that develop, revise and enhance clinical appropriateness guidelines.

Minimum Requirements:

• Requires MD or DO and Board certification by the American Board of Orthopedic Surgery or American Osteopathic Board of Orthopedic Surgery.

• Current unrestricted medical license(s) as a Doctor of Medicine or Doctor of Osteopathic Medicine in appropriate state(s).

• Experience performing standard orthopedic procedures independently.

Preferred Capabilities, Skills and Experiences:

• Minimum of 3 years of clinical practice experience past fellowship training preferred.

• Extensive orthopedic surgery experience preferred.

• Experience with utilization management, especially with CMS guidelines preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific positionis $223,822 to $424,095.

Locations: 

California; Colorado; District of Columbia (Washington, DC), Illinois, Maryland, Minnesota, Nevada; New York; Washington State

In addition to your salary, Elevance Health 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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consiste