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.