About the job
Must have: MD or DO, and currently licensed in Wisconsin
Job Description:
We are seeking a Medical Director to support utilization management and appeals oversight for a four-month engagement (April 1 – July 31) with the potential for extension based on business needs. This role will provide clinical leadership and adverse determination review across multiple lines of business, including Medicare Advantage, Commercial, and ACA plans.
Responsibilities:
• Assist the Chief Medical Officer (CMO) with monitoring the availability, appropriateness, and medical necessity of care rendered by participating and out-of-plan providers.
• Participate in oversight and clinical decision-making for the Utilization Management (UM) program.
• Render denial determinations for services not considered medically necessary or deemed experimental, investigational, or unproven in accordance with regulatory and quality standards.
• Review and manage approximately 5–10 appeals per day.
• Ensure appeals turnaround times are met (same day for expedited; two days for standard).
• Sign off on adverse determinations.
• Support all lines of business including Medicare Advantage (MA), Commercial, and ACA.
• No direct staff management responsibilities.
Requirements:
• Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction.
• Experience supporting multiple lines of business including ACA, Commercial, and Medicare Advantage.
• Available to work Monday–Friday, 8:00am–5:00pm Central Time.
• Proficiency with QuickBase, Microsoft Teams, and Microsoft Office Suite.
Key Skills:
• Utilization Management oversight
• Appeals review and adverse determinations
• Medical necessity review
• Multi-line of business expertise (MA, Commercial, ACA)
• Regulatory compliance and quality standards adherence
• Strong clinical judgment and decision-making
Pay Range:
150-165 hr w2
Benefits:
Our comprehensive benefits package includes:
o Medical insurance
o Dental insurance
o Vision insurance
o 401(k) retirement savings plan
Contact:
Karrie Ruch
+1 (312) 884-0418
kruch@jacobsongroup.com
Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!
Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.
If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsononline.com or +1 (800) 466-1578 to make a request.
