Lead Medical Director, Utilization Management
Core
Senior physician leadership role overseeing utilization management activities, ensuring members receive appropriate, timely, and evidence-based healthcare across outpatient and inpatient settings.
Role type
Senior physician leadership (Utilization Management)
Builds
Clinical policies, review consistency, and care quality outcomes for healthcare members
Domain
Healthcare / Utilization Management
Required skills
Clinical judgment, Medical necessity review, Team leadership, Policy development, Regulatory compliance, Data analysis, Peer-to-peer discussions, Committee chairing, Credentialing expertise, Quality improvement
Preferred skills
Board certification, Experience with complex cases, Multidisciplinary collaboration
Technologies
None stated
Responsibilities
Complete prior authorization and retrospective utilization management reviews; Lead and manage a team of Utilization Management Medical Directors; Develop and maintain clinical policies and medical necessity criteria; Chair the Utilization Management Committee; Serve on Credentialing and Quality Committees; Analyze audit findings and performance data to improve workflows; Advise organizational leaders on utilization management strategy.
Seniority
Senior, hands-on IC with leadership responsibilities