Medical Director – Utilization Management

🚨 Now Hiring:

• Medical Director – Utilization Management 🕒 100% Remote | Must work PST hours 🏥 Medicare Advantage | Inpatient & Post-Acute Focus We’re looking for an experienced Medical Director (Utilization Management) to help lead clinical integrity and medical necessity decision-making across inpatient and post-acute care services for Medicare Advantage members .



Reporting directly to the Chief Medical Officer , this physician leader will play a key role in ensuring appropriate, evidence-based, and compliant care decisions that support quality outcomes, cost efficiency, and regulatory excellence. 🔑 What You’ll Do Conduct medical necessity reviews for inpatient admissions, continued stays, and post-acute care (SNF, IRF, LTACH, Home Health) Apply MCG / InterQual guidelines and CMS criteria to utilization decisions Serve as physician reviewer for complex and escalated UM cases Participate in peer-to...