Physician Medical Director, Utilization Review

Job Description: The Medical Director is responsible for reviewing medical records, evaluating complex hospital-based clinical scenarios, and making expert determinations on requested services in alignment with national guidelines, CMS requirements, and organizational policies. This role requires frequent communication with external providers to gather clinical details and discuss decisions. Medical Directors work within structured processes, maintain high standards of professionalism and integrity, and contribute to a collaborative, team-oriented environment. Key Responsibilities  Conduct timely, compliant medical necessity reviews for inpatient services  Provide clear verbal and written determinations  Maintain strong productivity, quality, and compliance performance  Apply national guidelines and clinical standards to medical reviews  Adapt to evolving workflows, tools, and utilization management practices Required Qualifications  MD or DO with active, unrestricted medical license  Board certification in an ABMS specialty  5+ years of post-training clinical experience, preferably including inpatient care  Strong analytical, verbal, and written communication skills  Ability to work independently within a structured, team-based environment Preferred Qualifications  Experience in managed care or utilization management  Familiarity with MCG® or InterQual criteria  Background in hospital-based clinical practice  Technological adaptability and commitment to process improvement  Interest in teaching, presenting, or contributing to educational initiatives