With that USMLE score I would focus completely on ACGME programs - meaning you should attempt to rotate at 4-5 programs (2 weeks-1 month) and have yourself be a known applicant when your SF application comes across the desk. Get involved in a research project you can present/poster at a conference. Get at least 1 big wig letter. You have set yourself up with a good chance, the rest is up to you. Don't forget to have a back up plan nonetheless.