Top 697 Medical director utilization management Jobs

Utilization Review Medical Director (Contract)
Integra Partners —Remote
- $150 an hour
- Part-time
- Remote
- Medicine
- Home Health
- Senior level
- Paid parental leave
- Paid holidays
5d
Utilization Management Medical Director Contractor
Devoted Health —Remote
- Part-time
- Remote
- Senior level
- Dental insurance
- 401(k)
Medical Director II, Utilization Management
Devoted Health —Remote
- $280,000 - $345,000 a year
- Full-time
- Remote
- Medicine
- 3 years
- Senior level
- Dental insurance
- 401(k)
Medical Director, Utilization Management (Remote)
UPMC —Pittsburgh, PA
- Full-time
- Remote
- Medicine
- 5 years
- Geriatrics
- Health insurance
- Opportunities for advancement
3d
Medical Director - Utilization Management (Remote)
MRIoA —Remote
- $240,000 a year
- Weekends as needed
- Remote
- Background check
- Medicine
- 5 years
- AD&D insurance
- Paid holidays
Quick Apply
Utilization Management Medical Director- Remote
Optum —Boston, MA
- $248,500 - $373,000 a year
- Full-time
- Remote
- Medicine
- Microsoft Outlook
- 5 years
Quick Apply
12d
Medical Claims Review Medical Director - Remote
Optum —Atlanta, GA
- $248,500 - $373,000 a year
- Full-time
- Remote
- Medicine
- Microsoft Outlook
- 5 years
Quick Apply
5d
National Medical Director, Clinical AI Innovation and Performance - Remote
UnitedHealthcare —Minnetonka, MN
- $386,500 - $579,500 a year
- Full-time
- Remote
- Medicine
- BC/BE
- Pass drug screening
Executive Medical Director DME/HH
The Cigna Group —Remote
- $238,100 - $396,800 a year
- Weekends as needed
- Remote
- Medicine
- Home Health
- Mentoring
- Paid holidays
- Health insurance
10d
Medical Director - Part Time
Valenz —Remote
- Part-time
- Remote
- Medicine
- 5 years
- BC/BE
- Paid parental leave
- Health savings account
Medical Director, Care & Case Management
Included Health —Remote
- $240,720 - $310,000 a year
- Full-time
- Medicine
- 7 years
- Urgent Care
- Paid parental leave
- Disability insurance
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Medical Director - Inpatient Review
Humana —Remote
- $223,800 - $313,100 a year
- Weekends as needed
- Remote
- Medicine
- 5 years
- BC/BE
- Paid parental leave
- Paid holidays
Associate Medical Director, Physician Advisor for Utilization Management
Cedars-Sinai —Beverly Hills, CA
- $250,000 - $410,000 a year
- Part-time
- Medicine
- Organizational skills
- Fair chance
Medical Director
CareSource —Remote
- $195,200 - $341,600 a year
- Weekends as needed
- Remote
- Microsoft Word
- Medicine
- 5 years
Medical Director, Utilization Management
UPMC —Pittsburgh, PA
- Full-time
- Medicine
- Management
- 5 years
- Health insurance
- Opportunities for advancement
Medical Director
Delaware Valley Residential Care —Warminster, PA
- $2,500 - $3,500 a month
- Contract
- Medicine
- Doctoral degree
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
Medical Director Utilization Management, Clinical Specialty
quantum-health —Myrtle Point, OR
- Full-time
- Background check
- Medicine
- Management
- Continuing education credits
- Paid holidays
7d
PACE Medical Director, Jordan Valley Senior Care
Jordan Valley Health —Springfield, MO
- Full-time
- Medicine
- Current TB test
- Computer literacy
- Health savings account
- AD&D insurance
Quick Apply
Regional Medical Director- (Philadelphia/Baltimore)
CareAllies —Philadelphia, PA
- $191,500 - $355,600 a year
- Full-time
- Remote
- Medicine
- 3 years
- Analysis skills
- Paid parental leave
- Paid holidays
Medical Director - Physician
VitalCore Health Strategies —Georgetown, DE
- Full-time
- Medicine
- Anatomy knowledge
- BC/BE
- Health savings account
- Paid holidays
Quick Apply

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Utilization Review Medical Director (Contract)

Integra Partners -
Remote

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Job Details

Part-time
$150 an hour
5 days ago

Benefits

Paid parental leave
Paid holidays
Disability insurance
Health insurance
Dental insurance
Paid time off
Parental leave
Vision insurance
401(k) matching
Life insurance

Qualifications

Regulatory compliance
CMS regulatory compliance
Health insurance knowledge
Utilization management
Centers for Medicare and Medicaid Services (CMS)
Clinical documentation
Resource utilization in healthcare

Full Job Description

The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra’s Utilization Management (UM) operations. Role functions within a structured, high-volume authorization review queue and requires adherence to workflow timelines, clinical accuracy standards, and productivity expectations. The Medical Director ensures determinations are made in accordance with Medicare and Medicaid guidelines, health plan–specific criteria, internal policies, and regulatory requirements. This role is best suited for physicians who thrive in a process-driven environment and are committed to consistency, compliance, and evidence-based decision making.

The Utilization Review Medical Director’s responsibilities include but are not limited to:

Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria, including LCDs, Medicaid Manuals, InterQual, MCG, internal medical policies, and health plan requirements.
Function within a real-time review queue and maintain continuous case throughput in alignment with organizational turnaround and productivity standards.
Evaluate clinical documentation, identify missing elements, and render determinations supported by clear clinical rationale.
Review cases escalated by UM staff and/or UM Leadership when criteria do not apply to the enrollee’s unique clinical situation or when clinical judgment is required.
When appropriate, consult with external board-certified reviewers, engage with ordering practitioners, or conduct additional clinical dialogue prior to rendering a determination.
Participate in Peer-to-Peer (P2P) discussions, including maintaining availability for scheduled appointment times.
Document all clinical decisions clearly, concisely, and consistently in accordance with internal SOPs, NCQA standards, and regulatory expectations.
Maintain inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program.
Serve as a clinical resource for UM team, providing guidance on clinical interpretation, criteria application, and complex case review.
Support internal and external audit activities as needed, including NCQA accreditation, health plan audits, and state Medicaid reviews.
Notify leadership of observed trends, potential quality concerns, or opportunities to strengthen criteria alignment or operational workflows.
Maintain up-to-date knowledge of Medicare, Medicaid, DMEPOS policies, clinical standards of care, and regulatory updates relevant to UM.

Requirements:

MD or DO degree
Board certification in Internal Medicine, Family Medicine, or Physical Medicine & Rehabilitation
Eligible for participation in Medicare, Medicaid, and other federally funded programs; no current or past OIG or state sanctions
Experience performing utilization management or clinical review activities
Strong written and verbal communication skills with emphasis on documentation accuracy
Ability to work effectively in a high-volume, queue-based workflow with daily review expectations
Familiarity with electronic UM systems and authorization platforms
Experience with DMEPOS reviews
Experience with NCQA UM accreditation standards
Prior UM experience for MLTC, Medicaid, or Medicare Advantage plans

Working Conditions and Additional Expectations:

Remote role requiring consistent availability during standard business hours and responsiveness to daily assignments.
Case volume and mix vary; continuous throughput and timely review completion are required.
Must maintain a quiet, secure, and compliant environment for reviewing PHI and participating in P2P calls.
Secondary employment or consulting arrangements are permitted only if they do not interfere with the full-time expectations and require disclosure/approval.
Daily accountability measures, productivity monitoring, and adherence to all UM workflows are required.

Salary: $150.00/Hourly

Benefits Offered

Competitive compensation and annual bonus program
401(k) retirement program with company match
Company-paid life insurance
Company-paid short term disability coverage (location restrictions may apply)
Medical, Vision, and Dental benefits
Paid Time Off (PTO)
Paid Parental Leave
Sick Time
Paid company holidays and floating holidays
Quarterly company-sponsored events
Health and wellness programs
Career development opportunities

Remote Opportunities

We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.

Our Story

Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits.

With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.

Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.

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Refine Your Search

medical director utilization management jobs

Utilization Review Medical Director (Contract)

Utilization Management Medical Director Contractor

Medical Director II, Utilization Management

Medical Director, Utilization Management (Remote)

Medical Director - Utilization Management (Remote)

Utilization Management Medical Director- Remote

Medical Claims Review Medical Director - Remote

National Medical Director, Clinical AI Innovation and Performance - Remote

Executive Medical Director DME/HH

Medical Director - Part Time

Medical Director, Care & Case Management

Medical Director - Inpatient Review

Associate Medical Director, Physician Advisor for Utilization Management

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Medical Director, Utilization Management

Medical Director

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