State Licensed Lead Medical Director

Job Summary

To support a growing utilization management team, the remote State Licensed Lead Medical Director will evaluate outpatient referrals and inpatient admissions for medical appropriateness, manage a team of medical directors, and ensure clinical decisions align with established medical necessity criteria.

Key responsibilities

• Complete prior authorization and UM cases with sound clinical judgment and within established turnaround expectations
• Develop and maintain clinical policies and procedures while monitoring emerging evidence and recommending updates
• Chair the Utilization Management Committee, setting agendas and documenting decisions for effective follow-through

Required qualifications

• MD or DO degree with an active, unrestricted medical license
• Board certification in a relevant clinical specialty
• At least 5 years of clinical practice experience in utilization management or medical necessity review
• At least 5 years of leadership experience managing a clinical team
• Strong understanding of evidence-based guidelines and applicable regulatory requirements