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.
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.