Large managed care company is looking for a Medical Director to make utilization management determinations, identify utilization trends and suggest possible over or under utilization of services and proactively suggest improvements to the utilization management program.

WORK LOCATION: FULLY REMOTE

PAY: $115.00

CONTRACT DATES: 9/15/25 - 12/15/25

HOURS: M-F, 8-5. Must be able to work a flexible schedule that includes evening hours.

RESPONSIBILITIES

• Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values.
• Participates in case review and medical necessity determination.
• Conducts post service reviews issued for medical necessity and benefits determination coding.
• Assists in development of medical management, care management, and utilization management protocols.
• Oversees and ensures physician compliance with UM plan.
• Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met
  

QUALIFICIATIONS

• Master's degree
• Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.
• Board certification in Family Medicine or Internal Medicine
• An active, unrestricted medical license (any state)
• Five or more years of post-residency clinic practice experience
• Proficiency with Microsoft Office applications
• Two or more years of experience in utilization management activities preferred
• Two or more years of experience with acute admissions preferred
• Two years of experience working in a managed care health plan environment preferred
• Experience as a hospitalist is preferred
• Bilingual (English/Spanish) fluency preferred