Medical Director

Job Description

Job Description

Job Profile

Job Title : Medical Director

Location : Remote.

Hire Type : Contingent

Pay Range : $120 - $147 / hr.

Work Model : Remote

Work Shift : 8 hours per day 40 hrs. per week

Recruiter Contact : Sean Craft I sean@marykraft.com I 443-345-3305

Nature & Scope : Positional Overview

We are seeking a Medical Director – Utilization Management Physician to join our growing Utilization Management (UM) team. This role is ideal for a board-certified internal medicine or family medicine physician with strong experience in hospitalist medicine and a passion for improving health care efficiency and quality outcomes.

As a clinician-led organization, Optum empowers physicians to focus on what they do best—delivering high-quality, compassionate care—while supporting their professional growth and work-life balance. The Medical Director will play a pivotal role in evaluating medical necessities, guiding UM protocols, and ensuring compliance with CMS and health plan requirements.

Role & Responsibility :

Tasks That Will Lead to Your Success

• Conduct clinical reviews for medical necessity and appropriateness of services, with a focus on post-service and acute admissions.
• Assist in developing and maintaining UM protocols that align with CMS criteria, company standards, and accepted medical practices.
• Analyze utilization trends to detect over- or under-utilization and recommend corrective actions or process improvements.
• Contribute to the development of care management and medical management strategies and guidelines.
• Provide second-level review for escalated clinical cases as necessary.
• Stay current with CMS regulations and delegated health plan requirements related to UM.
• Ensure all reviews and decisions are well-documented and compliant with federal and state regulations.
• Support quality assurance by educating staff on current medical guidelines and evidence-based practices.
• Provide support and training to internal physicians and new hires on UM policies and review criteria.
• Maintain professional and responsive communication with peers, providers, and staff.
• Participate in medical team meetings, training sessions, and continuing education efforts.
• Promote a culture of collaboration, learning, and operational excellence within the UM team.

Skills & Experience

Qualifications That Will Help You Thrive