Medical Director; Utilization Management
Listed on 2026-01-29
-
Doctor/Physician
Healthcare Consultant, Internal Medicine Physician, Medical Doctor, Emergency Medicine Physician
Were looking for a Medical Director (Utilization Management) to guide clinical integrity in utilization management, focusing on inpatient and post-acute care reviews for Medicare Advantage members.
What Youll DoConduct utilization reviews and determine medical necessity for admissions and post-acute services.
Apply evidence-based guidelines (MCG, Inter Qual) and CMS criteria.
Collaborate with providers and UM/care management teams.
Participate in peer-to-peer reviews and UM committee meetings.
Support compliance, audits, and quality improvement initiatives.
Licensed M.D. or D.O. (in good standing).
5+ years clinical experience; 3+ years in UM/medical leadership in managed care.
Strong knowledge of Medicare Advantage regulations and CMS coverage.
Familiarity with MCG/Inter Qual criteria.
Preferred: MPH, MBA, MHA, or ABQAURP certification.
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).