Medical Director (Utilization Management)
Medical Director (Utilization Management)
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Job Description
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 Do:
Conduct utilization reviews and determine medical necessity for admissions and post-acute services.
Apply evidence-based guidelines (MCG InterQual) 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.
What Youll Bring:
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/InterQual criteria.
Preferred: MPH MBA MHA or ABQAURP certification.
Required Experience:
Director
Employment Type
Full-Time
