Medical Director (Utilization Management) en HJ Staffing

We’re looking for a Medical Director (Utilization Management) to guide clinical integrity in utilization management, focusing on inpatient and post-acute care reviews for Medicare Advantage members.

What You’ll Do:

• Conduct utilization reviews and determine medical necessity for admissions and post-acute services.

• Apply evidence-based guidelines (MCG, InterQual) and CMS criteria.

• Collaborate with providers and UM/care management teams.

• Participate in peer-to-peer reviews and UM committee meetings.

• Support compliance, audits, and quality improvement initiatives.

What You’ll Bring:

• Licensed M.D. or D.O. (in good standing).

• 5+ years clinical experience; 3+ years in UM/medical leadership in managed care.

• Strong knowledge of Medicare Advantage regulations and CMS coverage.

• Familiarity with MCG/InterQual criteria.

• Preferred: MPH, MBA, MHA, or ABQAURP certification.