Clin Ops Assoc Medical Dir-NS (US) at Elevance Health in Chicago, Illinois

Job Description:

Position specific details: Work schedule is 10:30am-7pm CST with flexibility for weekend coverage in the future. Voluntary overtime is periodically available based on business needs. Orthopedic Spine Surgeons are encouraged to apply.



The Clinical Operations Associate Medical Director - Neurosurgery/Orthopedic Spine is responsible for performing pre-authorizations and providing quality improvement solutions for musculoskeletal procedures involving the spine and/or joints, and high-tech diagnostic imaging.


Primary duties may include, but are not limited to:

• 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.

Position requirements:

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


• Additionally, American Board of Orthopedic Surgery with completion of fellowship training in Spine Surgery or American Osteopathic Board of Orthopedic Surgery with completion of fellowship training in Spine Surgery also meets the Board certification requirements for this position.


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


• Experience performing standard neurosurgical spine procedures independently.

Preferred qualifications, skills, and experiences:

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


• Extensive spine surgery experience preferred.


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


• Facile with computer usage including routine Microsoft products including Outlook, Word, OneNote, etc.


• Ability to work as a cooperative team member to accomplish business unit goals.


• Ability to work in a dynamic environment to meet deadlines.

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