Medical Director - Utilization Management

Job Summary

Seeking a part-time Medical Director - Utilization Management, the remote position will manage utilization management, medical necessity reviews, and appeals, requiring strong experience in managed care and clinical decision-making.

Key responsibilities

• Oversee utilization management and medical necessity review processes
• Conduct appeals reviews and provide physician leadership support
• Collaborate with interdisciplinary teams to ensure effective clinical decision-making

Required qualifications

• MD or DO with an active unrestricted medical license
• Board Certified in a relevant specialty
• Experience as a Medical Director, Associate Medical Director, or Physician Advisor
• Proven background in managed care, health plans, and utilization management
• Experience with medical necessity and appeals reviews