ALLMED Staffing
Overview
Large managed care company is looking for a Medical Director to make utilization management determinations, identify utilization trends and suggest possible over or under utilization of services and proactively suggest improvements to the utilization management program. Work location
WORK LOCATION: FULLY REMOTE Compensation
PAY: $115.00 Contract dates
CONTRACT DATES: 9/15/25 - 12/15/25 Hours
HOURS: M-F, 8-5. Must be able to work a flexible schedule that includes evening hours. Responsibilities
Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values. Participates in case review and medical necessity determination. Conducts post service reviews issued for medical necessity and benefits determination coding. Assists in development of medical management, care management, and utilization management protocols. Oversees and ensures physician compliance with UM plan. Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met Qualifications
Master's degree Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S. Board certification in Family Medicine or Internal Medicine An active, unrestricted medical license (any state) Five or more years of post-residency clinic practice experience Proficiency with Microsoft Office applications Two or more years of experience in utilization management activities preferred Two or more years of experience with acute admissions preferred Two years of experience working in a managed care health plan environment preferred Experience as a hospitalist is preferred Bilingual (English/Spanish) fluency preferred
#J-18808-Ljbffr
Large managed care company is looking for a Medical Director to make utilization management determinations, identify utilization trends and suggest possible over or under utilization of services and proactively suggest improvements to the utilization management program. Work location
WORK LOCATION: FULLY REMOTE Compensation
PAY: $115.00 Contract dates
CONTRACT DATES: 9/15/25 - 12/15/25 Hours
HOURS: M-F, 8-5. Must be able to work a flexible schedule that includes evening hours. Responsibilities
Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values. Participates in case review and medical necessity determination. Conducts post service reviews issued for medical necessity and benefits determination coding. Assists in development of medical management, care management, and utilization management protocols. Oversees and ensures physician compliance with UM plan. Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met Qualifications
Master's degree Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S. Board certification in Family Medicine or Internal Medicine An active, unrestricted medical license (any state) Five or more years of post-residency clinic practice experience Proficiency with Microsoft Office applications Two or more years of experience in utilization management activities preferred Two or more years of experience with acute admissions preferred Two years of experience working in a managed care health plan environment preferred Experience as a hospitalist is preferred Bilingual (English/Spanish) fluency preferred
#J-18808-Ljbffr