Medical Director – Utilization Management

This is a fully remote position, open to applicants in California.

📋 Description

• Conducts second level reviews in accordance with Medicare/CMS regulations.

• Assigns appropriate care classifications and performs continued stay reviews in line with CMS standards.

• Serves as a liaison among the medical team, utilization review, and third-party payers.

• Evaluates the complete claim denial process, encompassing Appeals and Grievances.

• Functions as a Physician representative on the utilization review team.

⛳️ Requirements

• A minimum of 3 years of experience in a hospital-wide or skilled nursing facility role that includes clinical care, quality management, utilization and case management, or medical staff governance is required.

• Completion of medical school and specialty residency (preferably in internal medicine) is required.

• Must hold current, unrestricted licensure as mandated for clinical practice in the state of California.

🏝️ Benefits

• Health insurance

• 401(k)

• Paid time off