Medical Director, Utilization Management (Home Health, Acute & Post-Acute)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medical Director, Utilization Management (Home Health, Acute & Post-Acute) based in United States.

• This role offers an opportunity for an experienced physician leader to serve as a key clinical authority within a remote utilization management environment.
• You will oversee medical necessity reviews for home health services while also supporting acute, post-acute, and outpatient reviews for Medicare Advantage populations.
• The position combines clinical decision-making, physician-to-physician collaboration, nursing mentorship, and evidence-based utilization management.
• You will apply CMS regulations, National and Local Coverage Determinations, MCG guidelines, and health plan medical policies to complex clinical cases.
• Working closely with nursing teams and provider organizations, you will help promote appropriate care, effective resource utilization, and positive health outcomes.
• The role also provides opportunities to contribute to clinical policy development, quality improvement, and technology-enabled care management initiatives.
• This is a fully remote, part-time position requiring availability during Eastern Time business hours.