Role: Associate Medical Director (Appeals & Utilization Management)
Location: 100% Remote (U.S. Based)
Client: Leading National Managed Care Organization
Are you a Board-Certified Physician looking to transition your clinical expertise into a high-impact leadership role? We are currently representing a premier national health services organization seeking an Associate Medical Director to join their clinical management team.
Our client oversees care for over 25 million members and is known for its commitment to workplace flexibility and clinical excellence. In this role, you will work closely with the Chief Medical Director to oversee the integrity of medical necessity decisions, quality improvement, and provider relations.
Core Responsibilities:
- Clinical Governance: Provide medical leadership for utilization management (UM), cost-containment strategies, and quality initiatives.
- Medical Reviews: Conduct high-level clinician reviews for complex, controversial, or experimental service requests, ensuring all decisions are timely and evidence-based.
- Appeals Advocacy: Collaborate with internal appeals teams and pharmacy consultants to resolve medical necessity disputes and complex case grievances.
- Quality & Policy: Help establish clinical goals and policies that improve the cost-effectiveness and quality of care; identify trends in provider practice patterns to reduce unwarranted clinical variation.
- Provider Engagement: Act as a clinical liaison to the provider community, assisting with physician education regarding medical policies and performance improvement.
- Operational Alliances: Represent the organization on state boards and national committees regarding medical philosophy and policy.
What We Are Looking For:
- Education: Unrestricted MD or DO degree is required.
- Board Certification: Active Board Certification (ABMS or AOA) is required. Candidates with backgrounds in Family Medicine or Internal Medicine are strongly preferred.
- Licensure: A current, valid state medical license without any active sanctions or restrictions.
- Experience: Previous experience in Utilization Management or Managed Care environments is highly desirable. Candidates should have a background in treating diverse patient populations.
- Knowledge: Familiarity with accreditation standards and health administration/financing is a plus.
- Availability: Ability to participate in a rotation for weekend/holiday coverage as business needs dictate.
Why Join Our Client?
- Compensation: Highly competitive salary range ($236,500 – $449,300) based on experience and geography.
- Flexibility: This is a fully remote position offering a true work-life balance.
- Comprehensive Benefits: Includes a robust 401k match, employee stock purchase options, tuition reimbursement, and generous PTO.
- Impact: Influence the healthcare journey for millions of members while moving away from high-volume bedside practice.
Our client is an equal opportunity employer committed to workforce diversity.
To Apply: Please submit your CV and a brief summary of your utilization management experience for a confidential screening call.
