UM Medical Director – Orthopedic Spine, Neurosurgery or Spine Surgery (Remote)
Location: Eden Prairie, Minnesota, USA (Remote Work Eligible)
Job Category: Medical & Clinical Operations
Requisition Number: 2301506
Estimated Salary: $270,000 – $330,000 per year (includes base pay + performance bonuses, depending on experience, licensure, and market)
About the Role:
Optum is seeking a Utilization Management (UM) Medical Director with specialization in Orthopedic Spine Surgery, Neurosurgery, or Spine Surgery. This remote-based role is responsible for clinical review, utilization management, and peer interactions to ensure appropriate care decisions based on evidence-based medicine and national guidelines. You will play a critical part in shaping high-quality, cost-effective healthcare across the musculoskeletal and spine care continuum.
Primary Responsibilities:
Perform clinical coverage reviews and determinations based on plan benefits and established review criteria, with a focus on musculoskeletal and spine surgery cases.
Participate in peer-to-peer provider discussions to ensure alignment on clinical decisions.
Review and document decisions in compliance with CMS, NCQA, URAC, and internal accreditation standards.
Assist with team oversight, support clinical review operations, and coach review staff.
Provide clinical interpretation of benefit plans and policies.
Participate in call coverage rotations (including weekends/holidays) to provide expedited telephonic and computer-based decisions.
Engage in performance consistency reviews, training, and continuous professional development.
Collaborate with internal teams and external providers to ensure accurate, timely coverage and elevate provider understanding of medical policy.
Required Qualifications:
Current, active, and unrestricted U.S. medical license.
Board Certification in Orthopedic Surgery or Neurosurgery (ABMS recognized).
5+ years of post-residency clinical experience, including spine surgery and musculoskeletal specialization.
Familiarity with evidence-based medicine (EBM) principles and utilization review standards.
Strong proficiency in Microsoft Office (Word, Excel, PowerPoint, Email).
Excellent communication and interpersonal skills, with comfort working via telephone and digital platforms.
Willingness to obtain additional state medical licenses as needed.
Preferred Qualifications:
Active license in South Carolina, Minnesota, or Texas (other state licenses also acceptable).
Managed care or health insurance Utilization Management (UM) experience.
Additional certifications or specialization relevant to spine or musculoskeletal care.
Familiarity with clinical/financial data integration and performance analytics.
Experience guiding providers and developing strategic clinical review processes.
Why Join Optum?
At Optum, part of UnitedHealth Group, you’ll be part of a global organization that is reshaping healthcare. Through technology, collaboration, and a commitment to equity, we strive to improve patient outcomes while offering flexible work environments, including fully remote opportunities. As a leader in clinical decision-making, your expertise will help reduce unnecessary procedures, improve quality of care, and drive operational excellence.
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Frank Scottile Blvd |Missouri :
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Germany | GErmany |Lower Saxony :
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Wavre |Tipperary :
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Dún Laoghaire |Galway :
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China | Quarry Bay |Liaoning :
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Hangzhou |Tokiyo :
Osaka | Tokyo |Shanghai Sai :
Shanghai Shi |Hubei :
Wuhan |Capital of Netherland :
Amsterdam |North Brabant :
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Netherlands |Remote Australia :
Arkansas | Remote Australia |New South Wales :
Ballina | Sydney |Republic of Western Australia :
Nedlands |Queensland :
Queensland |Melbourne :
South Yarra |United Kingdom :
England | Harlow | Leeds | London | Maidenhead | Salt Lake City | Stevenage | Stirling | United Kingdom |North Yorkshire :
Harrogate |South Yorkshire :
Sheffield |Oxfordshire :
Witney |Ontario :
Australia | Richmond Hill | Mississauga | Renfrew | North York | Uxbridge |Canada :
Canada |Quebec :
Montreal |Brussels :
Brussels |Antwerp :
Heist op den Berg |Flemish Brabant :
Zaventem |South America :
Argentina | Peru |Brazil :
Brazil | Sao paulo |Attica :
Athens | Koropi |Greece :
Greece |North Island :
Auckland |New Zealand :
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Austria |Vienna :
Vienna |Catalonia :
Barcelona |Madrid :
Madrid |Cebu Province :
Cebu City |Philippines :
Manila |Croatia :
Croatia |Zagreb :
Zagreb |Estonia :
Tartu | Estonia |Harju County (Maakond) :
Tallinn |Hà Nội :
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Ho Chi Minh City |Italy :
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Jakarta |East Java :
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New Mexico | Ciudad de México |Dubai :
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Kuala Lumpur |Kyiv Oblast :
Kyiv |Lima Region :
Lima |France :
Paris | Lyon |South Africa :
Midrand | South Africa |Nišava District :
Niš |Bohemia :
Prague |Chile :
Santiago |Bosnia and Herzegovina :
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