Part-Time Medical Director, Utilization Management - Remote

Overview

The Part-Time Medical Director of Utilization Management is responsible for providing medical expertise and leadership within the Utilization Management team, ensuring healthcare services meet quality standards and regulatory compliance.

In Short

• Part-time position, 20-25 hours per week.
• Collaboration with senior leaders and various stakeholders.
• Review clinical cases and provide medical expertise.
• Ensure adherence to Federal, State, and CMS compliant medical policies.
• Participate in case reviews and medical necessity determinations.
• Educate primary care physicians on compliance and market activities.
• Maintain accurate documentation of activities and decisions.
• Analyze data and serve as a liaison between physicians and health plan Medical Directors.
• Opportunity for involvement in special projects and training.
• Identify process improvement opportunities.

Requirements

• Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree.
• Board Certified Family Practitioner or Internal Medical Specialist preferred.
• Unrestricted license in at least one state in the USA.
• 5+ years of clinical practice experience.
• 2+ years of experience in utilization management activities.
• Proficiency with Microsoft Office applications.
• Previous experience in administrative oversight of medical functions.
• Strong interpersonal and organizational skills.
• Results-driven with excellent communication skills.
• Ability to work in a fast-paced environment.

Benefits

• Flexible work schedule.
• Opportunity to impact healthcare delivery.
• Collaborative work environment.
• Engagement in strategic and operational solutions.
• Involvement in special projects and training opportunities.