Medical Director – Utilization Management & Worker's Compensation

Core Responsibilities:

• Lead UM decisions and clinical oversight for medical necessity.
• Conduct peer-to-peer payer reviews to support authorizations and overturn denials.
• Educate providers on documentation and support audit response.

Required Qualifications:

• MD/DO with active unrestricted medical license and board certification.
• Prior experience in UM, physician advisory, or medical review.
• Strong understanding of payer criteria and effective clinician communication.

Preferred Experience:

• Experience with commercial payers and managed care.
• Documented success in peer-to-peer reviews overturning denials.
• Exposure to PE-backed or growth healthcare organizations.