California Licensed Medical Director

Job Summary

A company is looking for a Medical Director - Utilization Management (Part Time).

Key Responsibilities

• Provide physician oversight for outpatient utilization management activities, including prior authorizations and appeals
• Ensure medical necessity and appropriateness of outpatient services and support compliance with health plan requirements
• Conduct peer reviews and outpatient physician education to enhance documentation and guideline adherence

Required Qualifications

• MD or DO; Board Certified in Internal Medicine, Family Medicine, or relevant outpatient specialty
• Active, unrestricted medical license (California required)
• Prior experience in outpatient utilization management or health plan medical management
• Strong understanding of outpatient medical necessity criteria and prior authorization workflows
• Experience working with PCPs and ambulatory specialists in value-based care models