Medical Director, Utilization Management (Home Health, Acute & Post-Acute)

Role Overview:

• Serve as a key clinical authority in a remote utilization management environment.
• Focus on home health services while supporting acute, post-acute, and outpatient reviews for Medicare Advantage populations.

Accountabilities:

• Evaluate referrals, admissions, and authorization requests for medical necessity and appropriate levels of care.
• Conduct peer-to-peer discussions with physicians and provide clinical mentorship to nursing teams.
• Apply CMS requirements, NCD/LCD, MCG criteria, and medical policies to coverage determinations.

Qualifications:

• MD or DO degree with an active, unrestricted U.S. medical license.
• Board certification in Internal Medicine, Family Medicine, PM&R, Emergency Medicine, or related specialty.
• 1–2+ years of utilization management reviewer experience and 5+ years of direct clinical patient care experience.

Opportunities:

• Contribute to clinical policy development, quality improvement, and technology-enabled care management.
• Collaborate with experienced physicians, nurses, and clinical leaders in a fully remote setting.
• Provide impactful leadership and mentoring within multidisciplinary clinical teams.