Lead Medical Director, Utilization Management

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead Medical Director, Utilization Management based in the United States.

This is a senior physician leadership opportunity focused on ensuring members receive appropriate, timely, and evidence-based healthcare. You will oversee utilization management activities, providing clinical direction for medical necessity reviews across outpatient referrals, inpatient admissions, and other care requests. Alongside managing a team of Utilization Management Medical Directors, you will help shape clinical policies, strengthen review consistency, and guide complex or escalated cases. You will play a key role in multidisciplinary committees, collaborating with clinical, quality, compliance, pharmacy, and operational teams. By using clinical evidence, case trends, and performance data, you will identify opportunities to improve care quality, access, and outcomes. This remote-first role combines hands-on clinical judgment, strategic leadership, and a strong commitment to member-centered care.