For our client, we are seeking a Medical Director - UM Optimization to join the team of a leader in the Healthcare space.
This role will provide medical leadership for utilization management and cost containment initiatives within a complex healthcare environment. The Medical Director will partner with clinical teams, providers, and external stakeholders to support high-quality, cost-effective care and strengthen review processes for challenging cases. The position also plays an important role in quality improvement, policy development, and representation in public or regulatory forums as needed.
Location: Remote
Compensation: $215,000 – $408,500 annually
Responsibilities
- Provide medical leadership for utilization management and cost containment initiatives
- Conduct medical reviews for complex and controversial services
- Support performance improvement initiatives for capitated providers
- Assist in establishing goals and policies for quality and cost-effectiveness
- Collaborate with clinical teams and providers on complex cases and appeals
- Identify and evaluate trends in utilization and clinical quality improvement
- Represent the business unit in state committees and public forums as needed
Qualifications
- MD or DO with an unrestricted state medical license
- Board certification in a recognized medical specialty, specifically Psychiatry
- 5-7 years of experience in Utilization Management
- Strong background in quality improvement and accreditation standards
- Experience in managing care for diverse populations preferred
Benefits
- Comprehensive health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible work schedules including remote options
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.
