Medical Director – Utilization Management & Worker's Compensation

Council Capital is a healthcare-focused private equity firm based in Nashville, Tennessee, managing over $350 million in committed capital.

We invest in lower middle market healthcare companies where we see the potential to scale purpose and performance. Our investments span control and minority positions in businesses with enterprise values between $10 million and $100 million.

What sets us apart is the Council Model —a proven framework that surrounds founders and leadership teams with a powerful combination of support: our CEO Council of seasoned operators, our Strategic Healthcare Investors who bring real-world insight and access, and our internal Value Creation Team , focused on enabling growth through talent, systems, and strategy.

At Council Capital, we’re not just backing companies—we’re helping build enduring businesses that improve lives and shape the future of healthcare.

Core Responsibilities (What the Role Does)

Utilization Management Leadership

Serve as the primary physician resource for UM decision-making, escalations, and complex case reviews

Provide clinical oversight and guidance for medical necessity determinations

Support concurrent and retrospective review processes as needed

Peer-to-Peer & Payer Engagement

Conduct physician-to-physician reviews with payers to support authorization approvals and overturn denials

Partner with UM and Revenue Cycle teams to improve payer communication strategies

Identify payer-specific trends and opportunities to improve outcomes

Clinical Documentation & Education

Educate providers on documentation best practices tied to medical necessity and payer criteria

Identify recurring documentation gaps and implement corrective guidance

Support audit preparation and response from a clinical perspective

Collaboration & Reporting

Partner with Case Management, UM leadership, Revenue Cycle, Compliance, and Operations

Provide insights and recommendations based on denial trends and utilization data

Participate in leadership discussions related to utilization strategy and risk mitigation

Required Qualifications

MD or DO with an active, unrestricted medical license

Board Certified in a relevant specialty

Prior experience in Utilization Management, Physician Advisory, Medical Review, or similar role

Strong understanding of medical necessity, payer criteria, and utilization standards

Ability to communicate effectively with both clinicians and non-clinical leaders

Preferred Experience (Strongly Valued)

Experience working with commercial payers and managed care organizations

Prior peer-to-peer review experience with documented success overturning denials

Experience in outpatient, post-acute, or multi-site healthcare services environments

Exposure to healthcare services organizations operating in growth or PE-backed environments

Core Competencies (Scorecard Competencies)

Clinical Judgment – Applies sound, defensible medical decision-making

Influence Without Authority – Drives alignment across providers and payers

Communication – Clear, concise, and persuasive physician-to-physician dialogue

Decision-Making – Timely, confident, and data-informed

Business Acumen – Understands the financial and compliance implications of utilization decisions

What This Role Is Not

Not a purely academic or advisory-only position

Not a full-time practicing clinician role

Not a compliance-only or check-the-box function

This role requires ownership, judgment, and real engagement .

Council Capital and our portfolio companies are committed to building high-performing teams by hiring the best talent—period.

We believe in putting the right people in the right seats, regardless of background, and we’re always looking for individuals who bring fresh thinking, grit, and a drive to make a difference.

Thank you for considering a role with one of our companies. We’re excited to learn more about you.