Medical Director, Utilization Management-Remote

For our client, we are seeking a Medical Director, Utilization Management-Remote to join the team of a leader in the Healthcare space. This physician leader will provide clinical oversight for utilization review activities, helping ensure care decisions align with medical necessity standards and appropriate levels of care. The role partners closely with medical staff, interdisciplinary teams, and third-party payers to support quality outcomes, care coordination, and effective utilization practices. This opportunity is ideal for a board-certified physician who brings both hands-on clinical judgment and a strong understanding of healthcare delivery and reimbursement. Location: Remote - US based candidates only, no visa sponsorship available Compensation: $262,145 – $393,217 annually Responsibilities Conduct second-level reviews for compliance with Medicare/CMS guidelines Classify appropriate levels of care and conduct continued stay reviews Liaise with medical staff and third-party payers to promote appropriate care levels Manage the claim denial process, including appeals and grievances Serve as a physician member of the utilization review team and provide clinical oversight Monitor service utilization and collaborate on Utilization Management protocols Develop training materials and support annual physician testing Qualifications 3–5 years of experience in clinical care, quality management, or utilization management Completion of medical school and specialty residency, preferably in internal medicine Board certification and a current, unrestricted clinical practice license Subspecialty training or a post-residency fellowship preferred Strong understanding of healthcare delivery systems and reimbursement issues Benefits Flexible schedule with remote work opportunities Monday to Friday work hours with occasional weekend requirements Collaboration with interdisciplinary teams and a continuous improvement focus Participation in clinical oversight and quality outcomes Opportunity to build relationships with medical staff and leadership Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.