Orthopedic Surgery Associate Medical Director

Position Title Orthopedic Surgery Associate Medical Director – Clinical Operations Associate Medical Director Job Overview This role is responsible for performing pre‑authorizations and providing quality improvement solutions for musculoskeletal procedures involving joints. The position can be performed virtually full‑time, with occasional required in‑person training and onboarding sessions. Candidates must reside within a reasonable commuting distance of an approved location unless an accommodation is granted. Responsibilities Determine the medical necessity of requests using clinical criteria. Perform physician‑level case review of musculoskeletal utilization requests. Conduct peer‑to‑peer consultation with ordering physicians, physician assistants, and advanced practice nurses regarding established guidelines and accepted standards of care for treatments, surgical procedures, imaging, and appropriate sites of service. Provide education regarding applicable clinical criteria and discuss clinically appropriate alternative surgical and non‑surgical treatments. Perform first‑level provider appeals of coverage decisions. Support and educate internal clinical and non‑clinical staff on principles associated with appropriate musculoskeletal diagnoses, treatments, and management. Participate in physician team meetings. Participate in groups that develop, revise, and enhance clinical appropriateness guidelines. Qualifications MD or DO with board certification by the American Board of Orthopedic Surgery or American Osteopathic Board of Orthopedic Surgery. Current unrestricted medical license(s) in the appropriate state(s). Experience performing standard orthopedic procedures independently. Minimum of 5 years of clinical practice experience after fellowship training (preferred). Extensive orthopedic surgery experience (preferred). Experience with utilization management, especially with CMS guidelines (preferred). Location & Compensation Location: Illinois (virtual work is available; required in‑person training sessions and onboarding will be scheduled). Salary range for this position is $128.28/hr to $192.42/hr. The salary is based on legitimate, non‑discriminatory factors and may be modified after posting. Additional benefits include a comprehensive benefits package, equity stock purchase, 401(k) contribution, and other incentive and recognition programs. EEO Statement Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. #J-18808-Ljbffr The Elevance Health Companies, Inc.